Healthcare Provider Details

I. General information

NPI: 1093254385
Provider Name (Legal Business Name): SUSHAMA PRASAD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 S RED RD FL 33143
CORAL GABLES FL
33143-3647
US

IV. Provider business mailing address

6855 S RED RD
SOUTH MIAMI FL
33143-3647
US

V. Phone/Fax

Practice location:
  • Phone: 786-527-9810
  • Fax: 786-235-6251
Mailing address:
  • Phone: 786-527-9810
  • Fax: 786-235-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9262181
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9262181
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSP035304
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number234569
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberSP035304
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: