MEDICARE: MARISA ELENA SUTTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1033949193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA ELENA SUTTON

Provider Business Mailing Address
First Line	:	11300 NE 2ND AVE
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33161-6695
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9812 62ND TER S APT D
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-2821
Country	:	US
Telephone Number	:	609-617-1762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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Directions to “ MARISA ELENA SUTTON ” Practice Location

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