MEDICARE: SYDNEY O SUITE MD AND NICHOLAS D A SUITE MD 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	207R00000X	Internal Medicine Physician	ME0033083	FL

General Provider Information

NPI Number	:	1932390721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYDNEY O SUITE MD AND NICHOLAS D A SUITE MD PA

Provider Business Mailing Address
First Line	:	2525 EMBASSY DR
Second Line	:	SUITE 7
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4573
Country	:	US
Telephone Number	:	954-431-6884
Fax Number	:	954-436-6936

Provider Business Practice Location Address
First Line	:	2525 EMBASSY DR
Second Line	:	SUITE 7
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4573
Country	:	US
Telephone Number	:	954-431-6884
Fax Number	:	954-436-6936

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SYDNEY OSWALD SUITE
Credential	:	M.D.
Telephone Number	:	954-431-6884

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/22/2011

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