MEDICARE: DR. HILLARY SUTTON PH.D.

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	103TC0700X	Clinical Psychologist	PY5831	FL

General Provider Information

NPI Number	:	1164143657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILLARY SUTTON PH.D.

Provider Business Mailing Address
First Line	:	3 GATEHOUSE RD
Second Line	:
City	:	SEA RANCH LAKES
State	:	FL
Zip	:	33308-2906
Country	:	US
Telephone Number	:	954-856-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 GATEHOUSE RD
Second Line	:
City	:	SEA RANCH LAKES
State	:	FL
Zip	:	33308-2906
Country	:	US
Telephone Number	:	954-856-1073
Fax Number	:

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

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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