Provider Demographics
NPI:1265438394
Name:FORBES, SUSAN SHALDA (AUD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SHALDA
Last Name:FORBES
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4352
Mailing Address - Country:US
Mailing Address - Phone:941-922-3351
Mailing Address - Fax:941-927-5036
Practice Address - Street 1:4858 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4352
Practice Address - Country:US
Practice Address - Phone:941-922-3351
Practice Address - Fax:941-927-5036
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1722231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist