Provider Demographics
NPI:1821105289
Name:HOWARD, SUSAN WENTLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WENTLAND
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:WENTLAND
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 NORTH CLYDE MORRIS BLVD., SUITE 200
Mailing Address - Street 2:HALIFAX FAMILY HEALTH CENTER
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2765
Mailing Address - Country:US
Mailing Address - Phone:386-947-4665
Mailing Address - Fax:386-258-4891
Practice Address - Street 1:201 NORTH CLYDE MORRIS BLVD., SUITE 200
Practice Address - Street 2:HALIFAX FAMILY HEALTH CENTER
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2765
Practice Address - Country:US
Practice Address - Phone:386-947-4665
Practice Address - Fax:386-258-4891
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255504200Medicaid
FLB46964Medicare UPIN
FL255504200Medicaid