MEDICARE: MRS. SUHAILL GOLDSOTN

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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1538260989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUHAILL GOLDSOTN

Provider Business Mailing Address
First Line	:	8451 SW 37TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3207
Country	:	US
Telephone Number	:	786-506-1918
Fax Number	:

Provider Business Practice Location Address
First Line	:	9055 SW 87TH AVE
Second Line	:	305
City	:	MIAMI
State	:	FL
Zip	:	33176-2306
Country	:	US
Telephone Number	:	305-270-1361
Fax Number	:	305-270-9138

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/18/2012

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