Provider Demographics
NPI:1316218290
Name:CARTER, SUSAN AMANDA (AP, DOM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:AMANDA
Last Name:CARTER
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 1:7607 GRAND ESTUARY TRL UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-3236
Mailing Address - Country:US
Mailing Address - Phone:941-518-6237
Mailing Address - Fax:
Practice Address - Street 1:1859 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4901
Practice Address - Country:US
Practice Address - Phone:941-518-6237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3078171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist