Icely, Suzanne T

Icely, Suzanne T is an individual health care provider with primary practice located at 5959 Central Ave Ste 103 , St Petersburg FL 33710-8502. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Icely, Suzanne T can be contacted via phone (727) 767-6060.

Contact Information

Primary practice address
5959 Central Ave Ste 103 St Petersburg FL 33710-8502
Phone: (727) 767-6060
Fax: (727) 767-1285
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X ME0071624 Florida

Profile Details

NPI number 1720063613
LBN Legal business name Icely, Suzanne T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Oct 22nd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720063613 NPPES
Florida MEDICAID 255805000

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