Provider Demographics
NPI:1629352745
Name:STONE, SUSAN K (DOM, AP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:STONE
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 7TH AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205
Mailing Address - Country:US
Mailing Address - Phone:727-804-6795
Mailing Address - Fax:941-896-9746
Practice Address - Street 1:2620 MANATEE AVENUE W.
Practice Address - Street 2:SUITE C
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-896-9746
Practice Address - Fax:941-896-9746
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3032171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist