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General NPI Number Information
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NPI Number | 1265877930
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Entity Type | Individual
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Provider Name | DAWN SUKSANONG PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 2201 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8844
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Country | US
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Telephone | 727-388-9003
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Fax | 727-216-9743
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Provider Business Mailing Address
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Address Line | 2201 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33713-8844
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Country | US
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Telephone | 727-388-9003
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Fax | 727-216-9743
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9286
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License Number State | FL
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