Provider Demographics
NPI:1699248070
Name:REDDIE, SUZETTE LOIS
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:LOIS
Last Name:REDDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2041
Mailing Address - Country:US
Mailing Address - Phone:786-800-7127
Mailing Address - Fax:
Practice Address - Street 1:1910 82ND AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6990
Practice Address - Country:US
Practice Address - Phone:772-492-9841
Practice Address - Fax:772-492-9846
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator