Provider Demographics
NPI:1710987292
Name:SUEN, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SUEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 11TH CIR
Mailing Address - Street 2:STE 103
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4884
Mailing Address - Country:US
Mailing Address - Phone:772-770-4888
Mailing Address - Fax:772-770-0190
Practice Address - Street 1:3735 11TH CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4844
Practice Address - Country:US
Practice Address - Phone:772-770-4888
Practice Address - Fax:772-770-0190
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271760-1207RC0200X, 207RP1001X, 207RS0012X, 2083P0011X
FLME0062461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3708373-00Medicaid
FL15136ZMedicare PIN
FL3708373-00Medicaid