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General NPI Number Information
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NPI Number | 1396017513
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Entity Type | Organization
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Legal Business Name | SUZANNE PAVLOU MD PLLC
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 9858 CLINT MOORE RD SUITE C111-236
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-676-7488
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Fax | 561-910-4785
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Provider Business Mailing Address
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Address Line | 9858 CLINT MOORE RD SUITE C111-236
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City | BOCA RATON
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State | FL
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Zip | 33496-1034
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Country | US
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Telephone | 561-676-7488
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Fax | 561-910-4785
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SUZANNE PAVLOU
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Credential | MD
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Telephone | 561-676-7488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME90011
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License Number State | FL
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