Provider Demographics
NPI:1518985134
Name:SOUTHERLAND, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SOUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BEE RIDGE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7243
Mailing Address - Country:US
Mailing Address - Phone:941-924-9900
Mailing Address - Fax:941-924-9919
Practice Address - Street 1:3400 BEE RIDGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7243
Practice Address - Country:US
Practice Address - Phone:941-924-9900
Practice Address - Fax:941-924-9919
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78267208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259151100Medicaid
FL35423OtherBC FLORIDA