Basic Information
| Provider Information | |||||||||
| NPI: | 1679709695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLORIN | ||||||||
| FirstName: | SUZETTE | ||||||||
| MiddleName: | FAWZIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865357200 | ||||||||
| FaxNumber: | 7865357294 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 OPA LOCKA BLVD | ||||||||
| Address2: | |||||||||
| City: | OPA LOCKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330543528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865357200 | ||||||||
| FaxNumber: | 7865357294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 335868 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | ARNP9339659 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.