Basic Information
| Provider Information | |||||||||
| NPI: | 1548410053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUICO | ||||||||
| FirstName: | SHARLEEN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4510 DORR ST. | ||||||||
| Address2: | MS 840 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436152624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193834022 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3065 ARLINGTON AVE | ||||||||
| Address2: | MAILSTOP 1086 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436142570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835000 | ||||||||
| FaxNumber: | 4193833106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2008 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 35.093615 | OH | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2983535 | 05 | OH | MEDICAID |