Provider Demographics
NPI:1376714196
Name:BLANDI, SUZANNE
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BLANDI
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 1:221 N CAUSEWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5298
Mailing Address - Country:US
Mailing Address - Phone:386-427-2799
Mailing Address - Fax:386-478-1333
Practice Address - Street 1:221 N CAUSEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-5298
Practice Address - Country:US
Practice Address - Phone:386-427-2799
Practice Address - Fax:386-478-1333
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist