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General NPI Number Information
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NPI Number | 1043403231
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Entity Type | Individual
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Provider Name | SUE ANN BEREND PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 1471 RAYMOND EDWARDS RD
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City | HENRIETTA
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State | TX
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Zip | 76365-7297
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Country | US
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Telephone | 505-690-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 1471 RAYMOND EDWARDS RD
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City | HENRIETTA
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State | TX
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Zip | 76365-7297
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Country | US
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Telephone | 505-690-8357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | DI38592
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License Number State | FL
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