Provider Demographics
NPI:1952803884
Name:GOOD, SUE ELLEN
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3166
Mailing Address - Country:US
Mailing Address - Phone:941-492-9721
Mailing Address - Fax:
Practice Address - Street 1:701 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4808
Practice Address - Country:US
Practice Address - Phone:941-492-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator