Provider Demographics
NPI:1477243988
Name:SUID, OMAR
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:SUID
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 1:12001 DR M.L.K. JR STREET NORTH
Mailing Address - Street 2:3803
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1611
Mailing Address - Country:US
Mailing Address - Phone:727-318-0498
Mailing Address - Fax:
Practice Address - Street 1:12001 DR M.L.K. JR STREET NORTH
Practice Address - Street 2:3803
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1611
Practice Address - Country:US
Practice Address - Phone:727-318-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services