Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME88230 | FL |
NPI | 1124092473 |
---|---|
Provider Name | Mrs. Susan E. Desjardins |
First Address | Orlando, FL 32806-1215 |
Second Address | Orlando, FL 32806-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267945100 | (05) | FL |
ME88230 | MEDICAL LICENSE (01) | FL |