Provider Demographics
NPI:1437847613
Name:STEUSLOFF, ANTHONY GERALD
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GERALD
Last Name:STEUSLOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 RAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5160
Mailing Address - Country:US
Mailing Address - Phone:941-483-0746
Mailing Address - Fax:941-244-0107
Practice Address - Street 1:3600 WILLIAM PENN WAY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5236
Practice Address - Country:US
Practice Address - Phone:941-483-0746
Practice Address - Fax:941-244-0107
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist