Provider Demographics
NPI:1043403231
Name:BEREND, SUE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:BEREND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 RAYMOND EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-7297
Mailing Address - Country:US
Mailing Address - Phone:505-690-8357
Mailing Address - Fax:
Practice Address - Street 1:1471 RAYMOND EDWARDS RD
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365-7297
Practice Address - Country:US
Practice Address - Phone:505-690-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDI38592170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBERES1OtherDEPT. OF HEALTH
FLDI38592OtherDEPT. OF HEALTH
CADRM42OtherDEPT. OF HEALTH SERVICES