MEDICARE: SUSAN PRIMEAUX

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1447059241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PRIMEAUX

Provider Business Mailing Address
First Line	:	330 PAULS DR STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4716
Country	:	US
Telephone Number	:	813-655-4166
Fax Number	:	813-655-4814

Provider Business Practice Location Address
First Line	:	330 PAULS DR STE 200
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4716
Country	:	US
Telephone Number	:	813-655-4166
Fax Number	:	813-655-4814

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

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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Directions to “ SUSAN PRIMEAUX ” Practice Location

Language	Start Address	Practice Location

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