MEDICARE: DR. SUSAN AMANDA CARTER AP, DOM

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	171100000X	Acupuncturist	3078	FL

General Provider Information

NPI Number	:	1316218290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN AMANDA CARTER AP, DOM

Provider Business Mailing Address
First Line	:	7607 GRAND ESTUARY TRL UNIT 301
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34212-3236
Country	:	US
Telephone Number	:	941-518-6237
Fax Number	:

Provider Business Practice Location Address
First Line	:	1859 LAKEWOOD RANCH BLVD
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-4901
Country	:	US
Telephone Number	:	941-518-6237
Fax Number	:

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

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2012

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