Provider Demographics
NPI:1346545985
Name:HAYWOOD, COLETTE SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:SUSAN
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919771
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9771
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:
Practice Address - Street 1:3415 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1576
Practice Address - Country:US
Practice Address - Phone:239-344-2305
Practice Address - Fax:239-368-2044
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14CS6OtherBCBS
FL003559400Medicaid
FLFG201ZMedicare Oscar/Certification