Provider Demographics
NPI:1952587651
Name:DAVEY, SUZANNE LISA (OTR/L, CLT-LANA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LISA
Last Name:DAVEY
Suffix:
Gender:F
Credentials:OTR/L, CLT-LANA
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:LISA
Other - Last Name:HUMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CLT-LANA
Mailing Address - Street 1:110 N FEDERAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4300
Mailing Address - Country:US
Mailing Address - Phone:954-455-2121
Mailing Address - Fax:954-455-2324
Practice Address - Street 1:110 N FEDERAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4300
Practice Address - Country:US
Practice Address - Phone:954-455-2121
Practice Address - Fax:954-455-2324
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4191AOtherMEDICARE