Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036-043292 | IL |
N | 111NI0900X | Internist | 036-043292 | IL |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036-043292 | IL |
NPI | 1093793937 |
---|---|
Provider Name | Dr. Susan Shapiro Braithwaite |
First Address | Tallahassee, FL 32308-5436 |
Second Address | Tallahassee, FL 32308-5436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2005 |
Last Update Date | 06/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D12664 | (02) | |
F400165250 | MEDICARE PTAN (01) | IL |