Provider Demographics
NPI:1326792789
Name:D ADDARIO YEE, SUSAN K (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:D ADDARIO YEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 FIELDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8845
Mailing Address - Country:US
Mailing Address - Phone:407-751-0033
Mailing Address - Fax:
Practice Address - Street 1:2929 FIELDWOOD CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8845
Practice Address - Country:US
Practice Address - Phone:407-751-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1080363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical