Provider Demographics
NPI:1316410111
Name:SUTHERLAND, AYANNA ROXANNE
Entity Type:Individual
Prefix:MS
First Name:AYANNA
Middle Name:ROXANNE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 US HIGHWAY 1
Mailing Address - Street 2:STE 435C
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3829
Mailing Address - Country:US
Mailing Address - Phone:561-294-7741
Mailing Address - Fax:561-335-1077
Practice Address - Street 1:840 US HIGHWAY 1
Practice Address - Street 2:STE 435C
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3829
Practice Address - Country:US
Practice Address - Phone:561-444-5828
Practice Address - Fax:561-444-7852
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235031251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY460780064OtherCOMPANION SERVICES
FL460780064Medicaid