MEDICARE: SULE SIZEMORE PA

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	363AM0700X	Medical Physician Assistant	0092921	NY
2	363AM0700X	Medical Physician Assistant	1483	SC
3	363A00000X	Physician Assistant	PA9110643	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871546440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SULE SIZEMORE PA

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 PHILIPS HWY # 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6730
Country	:	US
Telephone Number	:	904-839-1018
Fax Number	:	904-656-7279

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	12/10/2024

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Directions to “ SULE SIZEMORE PA” Practice Location

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