Susan G. Ellis, PH.D., P.a.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY2173 Issued in FL

Legal business name

SUSAN G. ELLIS, PH.D., P.A.

Practice address

3233 E Bay Dr
Suite 100
Largo, FL 33771-1900

Phone

(727) 536-2200

Fax

(727) 531-5088

NPI assigned

Dec 21, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Susan G. Ellis, PH.D.NPI 1578633350

Title

President

Phone

(727) 536-2200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Susan G Ellis, PH.D.

  • Clinical Psychologist
  • Largo, FL
  • NPI 1578633350
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261353600000",
    "number": "1801125869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3233 E BAY DR",
            "address_2": "SUITE 100",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337711900",
            "telephone_number": "727-536-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3233 E BAY DR",
            "address_2": "SUITE 100",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337711900",
            "telephone_number": "727-536-2200",
            "fax_number": "727-531-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN G. ELLIS, PH.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2009-12-21",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-536-2200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY2173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Superior Medical Equipment Plus LLC
• Support Services for Independent Living, Inc.
• Supreme Healthcare of Florida
• Amy Surber
• Surgcenter Pinellas, LLC
• Susanti K Chowdhury MD PA
• Susanti K. Chowdhury MD PA
• Catherine Myrene Suttle, APRN
• Claire A Sutton, M.A., BCBA
• William Eugene Swager IV

• Clinical Psychologist in Largo, FL
• Providers in Largo, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.