Suzanne Depaulo, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DR.0053278 Issued in CO

Practice address

1190 Fortune Blvd
Shiloh, IL 62269-7358

Phone

(314) 286-6988

NPI assigned

Nov 8, 2007

Last updated

Apr 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1487834206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2417 OAKGROVE CIR",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622251447",
            "telephone_number": "787-720-5956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 FORTUNE BLVD",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622697358",
            "telephone_number": "314-286-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPAULO",
        "first_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-08",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0053278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla McKinley Daniels
• Cynthia Ann Davis, RN
• Lydia Noel Davis, APRN
• Mahal Deck, WHNP-BC
• Jordan Dellamano, PT
• DHP of Illinois SC
• Molly Elizabeth Diecker
• Dierbergs Markets Inc (Dierbergs Green Mount Crossing Pharmacy)
• Robert J Dizes Jr., PA-C
• Kathryn Marie Dominick, DO

• Family Medicine Physician in Shiloh, IL
• Providers in Shiloh, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.