Provider Demographics
NPI:1255842076
Name:SUGZDINIS, EDMUND DEFOREST I (HEARING INSTRUMENT S)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:DEFOREST
Last Name:SUGZDINIS
Suffix:I
Gender:M
Credentials:HEARING INSTRUMENT S
Other - Prefix:MR
Other - First Name:NED
Other - Middle Name:
Other - Last Name:SUGZDINIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AS5319
Mailing Address - Street 1:1920 QUAKER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8089
Mailing Address - Country:US
Mailing Address - Phone:302-229-6883
Mailing Address - Fax:
Practice Address - Street 1:439 NORTH ST STE D
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-2901
Practice Address - Country:US
Practice Address - Phone:904-805-3869
Practice Address - Fax:904-805-3869
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS9491237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist