Provider Demographics
NPI:1326363466
Name:LEE, SUYIN J (DO)
Entity Type:Individual
Prefix:DR
First Name:SUYIN
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0385
Mailing Address - Country:US
Mailing Address - Phone:904-671-0288
Mailing Address - Fax:904-508-0674
Practice Address - Street 1:165 DURBIN STATION CT STE 601
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-9370
Practice Address - Country:US
Practice Address - Phone:904-671-0288
Practice Address - Fax:904-508-0674
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018898208100000X
GA71696208100000X
FLOS121242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation