{
"Npi": {
"NPI": "1255842076",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SUGZDINIS",
"FirstName": "EDMUND",
"MiddleName": "DEFOREST",
"NamePrefix": "MR.",
"NameSuffix": "I",
"Credential": "HEARING INSTRUMENT S",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SUGZDINIS",
"OtherFirstName": "NED",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "AS5319",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1920 QUAKER RIDGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GREEN COVE SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32043-8089",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "302-229-6883",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "439 NORTH ST STE D",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GREEN COVE SPRINGS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32043-2901",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-805-3869",
"PracticeLocationAddressFaxNumber": "904-805-3869",
"EnumerationDate": "10/19/2017",
"LastUpdateDate": "10/19/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237700000X",
"TaxonomyName": "Hearing Instrument Specialist",
"LicenseNumber": "AS9491",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}