Susely C Rodriguez, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

9115448 Issued in FL

Practice address

1250 S Harbor City Blvd
Melbourne, FL 32901-3242

Phone

(321) 725-8919

NPI assigned

Feb 21, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: srodriguez71785@epicdirect.hf.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brevard Physician Associates, PLLC

  • Anesthesiology Physician
  • Melbourne, FL
  • NPI 1598008955
  Medicare reassignment

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

{
    "created_epoch": "1645401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1750036455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7208 WANDO AVE",
            "city": "GRANT",
            "state": "FL",
            "postal_code": "329495350",
            "telephone_number": "321-986-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S HARBOR CITY BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329013242",
            "telephone_number": "321-725-8919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SUSELY",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9115448",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "9115448",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9115448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marisa L Rodriguez
• Michelle Rodriguez
• Naomi Celeste Rodriguez
• Raymond Peter Rodriguez, ATC, LAT
• Rosellen Rodriguez
• Talisa Rodriguez, DO
• Victor Jesus Rodriguez Jr., RD
• Wayne D Rodriguez, MD
• Heather Roe, MS, LMHC
• Kristen Alexandria Roff, FNP-C

• Physician Assistant in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; 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.