Provider Demographics
NPI:1588926166
Name:SUYAT, MARIANNE (AP , DOM)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:SUYAT
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 1:5222 ANDRUS AVE STE D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:407-412-6354
Mailing Address - Fax:
Practice Address - Street 1:5222 ANDRUS AVE STE D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:407-412-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3142171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist