MEDICARE: DR. NOUR Z. SUID MA, PSYD

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	101YP2500X	Professional Counselor	005237	CT
2	101YP2500X	Professional Counselor	1-58423-1B	VI

General Provider Information

NPI Number	:	1306318613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOUR Z. SUID MA, PSYD

Provider Business Mailing Address
First Line	:	PO BOX 302278
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00803-2278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5316 YACHT HAVEN GRANDE STE S104
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00802-5027
Country	:	US
Telephone Number	:	340-513-0418
Fax Number	:

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

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	08/23/2022

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