Provider Demographics
NPI:1477881118
Name:SUZELIS, TED (ND)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:SUZELIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1605
Mailing Address - Country:US
Mailing Address - Phone:330-872-1577
Mailing Address - Fax:
Practice Address - Street 1:38 W BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1605
Practice Address - Country:US
Practice Address - Phone:330-872-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000113175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath