=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558384016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE ABBIE SUVAL DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2006
-----------------------------------------------------
Last Update Date | 01/17/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13590 JOG RD SUITE 2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-865-3331
-----------------------------------------------------
Fax | 561-865-3332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13590 JOG RD SUITE 2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-865-3331
-----------------------------------------------------
Fax | 561-865-3332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO1840
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------