Healthcare Provider Details

I. General information

NPI: 1689893885
Provider Name (Legal Business Name): SUVY KURIAKOSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUVY VATTASSERIL M.D.

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 MAGUIRE RD
OCOEE FL
34761
US

IV. Provider business mailing address

3090 CARUSO CT STE 50
ORLANDO FL
32806-8510
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3080
  • Fax: 407-636-7804
Mailing address:
  • Phone: 407-481-7179
  • Fax: 407-481-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number243468
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: