Provider Demographics
NPI:1316140395
Name:CESARANO, SUE NICHOLS (AP, DOM)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:NICHOLS
Last Name:CESARANO
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 S.W. 57 AVE.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-662-2345
Mailing Address - Fax:305-662-2343
Practice Address - Street 1:7800 S.W. 57 AVE.
Practice Address - Street 2:SUITE 108
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-662-2345
Practice Address - Fax:305-662-2343
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist