Provider Demographics
NPI:1639113632
Name:CUTTLER, SUSAN PASTINA (AUD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PASTINA
Last Name:CUTTLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:PASTINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3506
Mailing Address - Country:US
Mailing Address - Phone:352-238-3522
Mailing Address - Fax:
Practice Address - Street 1:13178 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4896
Practice Address - Country:US
Practice Address - Phone:352-597-5540
Practice Address - Fax:352-597-5544
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY361231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600103300Medicaid
FL4899980OtherGHI
FL600103300Medicaid
FLS1666ZMedicare PIN