Provider Demographics
NPI:1942309042
Name:ANTELL, SUE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:E
Last Name:ANTELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22659 ESPLANADA CIR W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5918
Mailing Address - Country:US
Mailing Address - Phone:561-893-8199
Mailing Address - Fax:561-893-6334
Practice Address - Street 1:551 NW 77TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1330
Practice Address - Country:US
Practice Address - Phone:561-893-8199
Practice Address - Fax:561-893-6334
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7099103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist