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General NPI Number Information
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NPI Number | 1104490838
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Entity Type | Individual
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Provider Name | SUSSEL GANDUR MARTINEZ ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 8900 N KENDALL DR
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City | MIAMI
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State | FL
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Zip | 33176-2197
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Country | US
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Telephone | 305-928-7249
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Fax | 305-630-3632
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Provider Business Mailing Address
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Address Line | 6021 NW 201ST ST
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City | HIALEAH
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State | FL
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Zip | 33015-4889
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Country | US
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Telephone | 786-503-9520
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | APRN11008348
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License Number State | FL
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