Healthcare Provider Details

I. General information

NPI: 1740423656
Provider Name (Legal Business Name): SUKATI LEE MILLER CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33870 BLUE STAR HWY APT 903
MIDWAY FL
32343-2433
US

IV. Provider business mailing address

33870 BLUE STAR HWY APT 903
MIDWAY FL
32343-2433
US

V. Phone/Fax

Practice location:
  • Phone: 315-395-9010
  • Fax:
Mailing address:
  • Phone: 315-395-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number132716R
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number343453230813E
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: