MEDICARE: AMANDA KRISTINE SUGGS

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	207N00000X	Dermatology Physician	ME141299	FL

General Provider Information

NPI Number	:	1609135599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KRISTINE SUGGS

Provider Business Mailing Address
First Line	:	11030 RCA CENTER DR STE 3015
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4276
Country	:	US
Telephone Number	:	561-776-7041
Fax Number	:

Provider Business Practice Location Address
First Line	:	11030 RCA CENTER DR STE 3015
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4276
Country	:	US
Telephone Number	:	561-776-7041
Fax Number	:

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

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	10/30/2019

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