Provider Demographics
NPI:1184609539
Name:CHANDLER, SUZETTE AVA (DO)
Entity type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:AVA
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PREVATT ST
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6149
Mailing Address - Country:US
Mailing Address - Phone:352-589-5890
Mailing Address - Fax:352-589-2589
Practice Address - Street 1:2000 PREVATT ST
Practice Address - Street 2:SUITE B-2
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6149
Practice Address - Country:US
Practice Address - Phone:352-589-5890
Practice Address - Fax:352-589-2589
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260323300Medicaid
FL51836OtherBLUE CROSS BLUE SHIELD NU
FL260323300Medicaid
FL51836OtherBLUE CROSS BLUE SHIELD NU