Provider Demographics
NPI:1124907589
Name:SUSSMAN, ELKE (PA-C)
Entity type:Individual
Prefix:
First Name:ELKE
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20404 SW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2501
Mailing Address - Country:US
Mailing Address - Phone:305-878-1689
Mailing Address - Fax:
Practice Address - Street 1:20404 SW 85TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2501
Practice Address - Country:US
Practice Address - Phone:305-878-1689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant