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General NPI Number Information
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NPI Number | 1689737769
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Entity Type | Individual
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Provider Name | SUSAN CHERIE SULT PH. D.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 204 N PARK AVE STE 100
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City | SANFORD
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State | FL
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Zip | 32771-1293
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Country | US
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Telephone | 407-330-0418
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Fax | 407-321-0059
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Provider Business Mailing Address
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Address Line | PO BOX 2525
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City | SANFORD
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State | FL
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Zip | 32772-2525
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Country | US
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Telephone | 407-330-0418
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Fax | 407-321-0059
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 3854
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License Number State | FL
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