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General NPI Number Information
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NPI Number | 1700854833
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Entity Type | Individual
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Provider Name | EDWARD SUPINSKI MD
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3691 CLYDE MORRIS BLVD
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City | PORT ORANGE
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State | FL
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Zip | 32129-2317
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Country | US
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Telephone | 386-675-4411
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Fax | 866-542-5859
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 200
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City | MIAMI
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State | FL
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Zip | 33126-3168
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Country | US
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Telephone |
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Fax | 386-676-7125
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 80671
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License Number State | FL
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