Provider Demographics
NPI:1548410053
Name:SUICO, SHARLEEN ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARLEEN
Middle Name:ANNE
Last Name:SUICO
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 1:4510 DORR ST.
Mailing Address - Street 2:MS 840
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2624
Mailing Address - Country:US
Mailing Address - Phone:419-383-4022
Mailing Address - Fax:
Practice Address - Street 1:3065 ARLINGTON AVE
Practice Address - Street 2:MAILSTOP 1086
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2570
Practice Address - Country:US
Practice Address - Phone:419-383-5000
Practice Address - Fax:419-383-3106
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093615208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2983535Medicaid