Provider Demographics
NPI:1811200165
Name:SALHAB, SUZANNE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:A
Last Name:SALHAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:A
Other - Last Name:SALHAB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11808 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1536
Mailing Address - Country:US
Mailing Address - Phone:813-769-9866
Mailing Address - Fax:813-315-6313
Practice Address - Street 1:11808 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1536
Practice Address - Country:US
Practice Address - Phone:813-769-9866
Practice Address - Fax:813-315-6313
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119290208VP0000X, 174400000X, 207Q00000X, 207QH0002X, 2083B0002X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01430305OtherR&R MEDICARE
FL651548Medicaid
FLME119290OtherACTIVE LICENSE
FL651548Medicaid