Provider Demographics
NPI:1184784845
Name:SUTHERLAND, DEON KEIVA-MARIE (MD)
Entity type:Individual
Prefix:
First Name:DEON
Middle Name:KEIVA-MARIE
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:1575 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-674-1740
Practice Address - Fax:352-674-8940
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00470650OtherRR MEDICARE
FL37004OtherBCBS - FL
FLP00470650Medicare PIN
FLU5555YMedicare PIN
FLI38344Medicare UPIN
FLU5555ZMedicare PIN