Healthcare Provider Details

I. General information

NPI: 1205382322
Provider Name (Legal Business Name): ASHLEY CANDICE SOOKLAL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 WELLNESS LN BLDG 4
NEW PORT RICHEY FL
34655-5357
US

IV. Provider business mailing address

4104 W LINEBAUGH AVE
TAMPA FL
33624-5239
US

V. Phone/Fax

Practice location:
  • Phone: 727-264-8888
  • Fax:
Mailing address:
  • Phone: 813-229-2225
  • Fax: 813-221-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11951
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: