Icely, Suzanne T
Icely, Suzanne T is an individual health care provider with primary practice located at 5959 Central Ave Ste 103 , St Petersburg FL 33710-8502. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Icely, Suzanne T can be contacted via phone (727) 767-6060.Contact Information
Primary practice address
5959 Central Ave Ste 103
St Petersburg FL 33710-8502
Phone: (727) 767-6060
Fax: (727) 767-1285
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | ME0071624 | Florida |
Profile Details
| NPI number | 1720063613 |
|---|---|
| LBN Legal business name | Icely, Suzanne T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 13th, 2005 |
| Last updated | Oct 22nd, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720063613 | NPPES |
| Florida | MEDICAID | 255805000 |
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