Provider Demographics
NPI:1003323429
Name:LIST, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:827 18TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6481
Mailing Address - Country:US
Mailing Address - Phone:772-925-8200
Mailing Address - Fax:772-925-8199
Practice Address - Street 1:981 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6541
Practice Address - Country:US
Practice Address - Phone:772-492-3427
Practice Address - Fax:772-999-5577
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME698972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry