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NPI Code Detail

MEDICARE: MRS. SUSANNA ELIZABETH DUFFANY PTA

MEDICARE: MRS. SUSANNA ELIZABETH DUFFANY PTA
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
1172V00000XCommunity Health WorkerPTA1796FL

General Provider Information

NPI Number : 1851570840
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSANNA ELIZABETH DUFFANY PTA
Provider Business Mailing Address
First Line : 1705 17TH AVE
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-3641
Country : US
Telephone Number : 772-562-6877
Fax Number : 772-562-3153
Provider Business Practice Location Address
First Line : 1705 17TH AVE
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-3641
Country : US
Telephone Number : 772-562-6877
Fax Number : 772-562-3153
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2007
Last Update Date : 10/26/2007

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