Provider Demographics
NPI:1235168659
Name:DEMMING, SUZANNE M (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:DEMMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3824 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6263
Mailing Address - Country:US
Mailing Address - Phone:407-425-7188
Mailing Address - Fax:407-423-9040
Practice Address - Street 1:529 HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1493
Practice Address - Country:US
Practice Address - Phone:386-254-1951
Practice Address - Fax:386-239-9758
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME51036207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055626200Medicaid
FL180027278OtherRR MEDICARE
FLC75151Medicare UPIN
FL055626200Medicaid