Provider Demographics
NPI:1215955406
Name:SULESKEY, CHARLES A (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:SULESKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3127
Mailing Address - Country:US
Mailing Address - Phone:941-493-7999
Mailing Address - Fax:941-493-6852
Practice Address - Street 1:1832 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3127
Practice Address - Country:US
Practice Address - Phone:941-493-7999
Practice Address - Fax:941-493-6852
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1729213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87901OtherBCBS
FL480029500OtherRR MEDICARE
FL1021460001Medicare NSC
FL87901OtherBCBS
FLT55595Medicare UPIN