Provider Demographics
NPI:1689737769
Name:SULT, SUSAN CHERIE (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHERIE
Last Name:SULT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2525
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-2525
Mailing Address - Country:US
Mailing Address - Phone:407-330-0418
Mailing Address - Fax:407-321-0059
Practice Address - Street 1:204 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1293
Practice Address - Country:US
Practice Address - Phone:407-330-0418
Practice Address - Fax:407-321-0059
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3854103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014309900Medicaid
FL00073245Medicare UPIN