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General NPI Number Information
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NPI Number | 1326363466
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Entity Type | Individual
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Provider Name | SUYIN J LEE D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 165 DURBIN STATION CT STE 601
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City | ST JOHNS
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State | FL
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Zip | 32259-9370
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Country | US
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Telephone | 904-671-0288
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Fax | 904-508-0674
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Provider Business Mailing Address
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Address Line | PO BOX 385
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32004-0385
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Country | US
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Telephone | 904-671-0288
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Fax | 904-508-0674
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101018898
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 71696
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS12124
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License Number State | FL
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