Individual
DR. SUZANNE T ICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5959 CENTRAL AVE STE 103, ST PETERSBURG, FL 33710-8502
(727) 767-6060
(727) 767-1285
Mailing address
5959 CENTRAL AVE STE 103, ST PETERSBURG, FL 33710-8502
(727) 767-6060
(727) 767-1285
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME0071624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255805000
—
FL
Enumeration date
12/13/2005
Last updated
10/22/2021
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