Healthcare Provider Details

I. General information

NPI: 1477160059
Provider Name (Legal Business Name): SUSAN SUKHU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 ARMSTRONG BLVD
KISSIMMEE FL
34741-2589
US

IV. Provider business mailing address

3863 WIND DANCER CIR
SAINT CLOUD FL
34772-8273
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-5732
  • Fax: 407-965-4263
Mailing address:
  • Phone: 321-750-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: