Provider Demographics
NPI:1730185133
Name:LEE, SUZY (MD)
Entity type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 FOUNTAIN MEDICAL CT
Mailing Address - Street 2:STE E100
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4625
Mailing Address - Country:US
Mailing Address - Phone:239-221-8516
Mailing Address - Fax:239-221-8787
Practice Address - Street 1:9411 FOUNTAIN MEDICAL CT
Practice Address - Street 2:STE E100
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4625
Practice Address - Country:US
Practice Address - Phone:239-221-8516
Practice Address - Fax:239-221-8787
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76644207N00000X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1541YOtherMEDICARE INDIVIDUAL
FL002UEOtherBCBS GROUP
FLP01091011OtherRAILROAD MEDICARE INDIVIDUAL
FL45-4144852OtherTAX ID
FLDT0473OtherRAILROAD MEDICARE GROUP
FL44836OtherBCBS FL
FLFY111AOtherMEDICARE GROUP
FLDT0473OtherRAILROAD MEDICARE GROUP