Healthcare Provider Details

I. General information

NPI: 1053883041
Provider Name (Legal Business Name): SUTHIDA BAYRASY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2019
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 CORPOREX PARK DR STE 115
TAMPA FL
33619-1179
US

IV. Provider business mailing address

306 S WESTLAND AVE APT 1
TAMPA FL
33606-1802
US

V. Phone/Fax

Practice location:
  • Phone: 727-803-0023
  • Fax:
Mailing address:
  • Phone: 727-600-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number37842
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS62989
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: