Provider Demographics
NPI:1437841152
Name:DAYTONA BEACH VASCULAR ACCESS, LLC
Entity Type:Organization
Organization Name:DAYTONA BEACH VASCULAR ACCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-251-5741
Mailing Address - Street 1:1180 N WILLIAMSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-8176
Mailing Address - Country:US
Mailing Address - Phone:386-274-4244
Mailing Address - Fax:
Practice Address - Street 1:1873 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5518
Practice Address - Country:US
Practice Address - Phone:386-274-4244
Practice Address - Fax:386-274-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical