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General NPI Number Information
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NPI Number | 1306122973
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Entity Type | Individual
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Provider Name | WEIDONG SU PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 11565 N MAIN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4002
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Country | US
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Telephone | 904-757-2811
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Fax | 904-757-0191
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Provider Business Mailing Address
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Address Line | 8923 HAMPTON LANDING DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4585
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Country | US
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Telephone | 904-349-6856
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Fax | 904-757-1220
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106187
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License Number State | FL
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