Provider Demographics
NPI:1487303608
Name:LONDONO, SUSANA (DPM)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:LONDONO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLEVELAND ST STE 501-12
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4172
Mailing Address - Country:US
Mailing Address - Phone:727-304-5373
Mailing Address - Fax:727-655-9622
Practice Address - Street 1:601 CLEVELAND ST STE 501-12
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4172
Practice Address - Country:US
Practice Address - Phone:727-304-5373
Practice Address - Fax:727-655-9622
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4612213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery