Provider Demographics
NPI:1134209448
Name:SCHOPBACH, SUSAN (DOM, AP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHOPBACH
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MORTON LN
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708
Mailing Address - Country:US
Mailing Address - Phone:407-718-5795
Mailing Address - Fax:321-296-1927
Practice Address - Street 1:2221 LEE RD.
Practice Address - Street 2:SUITE 14
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-718-5795
Practice Address - Fax:321-296-1927
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1479171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0947OtherBCBS