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1063397891 NPI number — SUTRAH JOSEPH PA-C

NPI Number: 1063397891
Health Care Provider/Practitioner: SUTRAH JOSEPH PA-C

Information about “1063397891” NPI (SUTRAH JOSEPH PA-C) exists in 1063397891 in HTML format HTML  |  1063397891 in plain Text format TXT  |  1063397891 in PDF (Portable Document Format) PDF  |  1063397891 in an XML format XML  formats.

NPI Number : 1063397891 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063397891",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOSEPH",
    "FirstName": "SUTRAH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "11253 CORAL REEF DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOCA RATON",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33498-1966",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-756-2617",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3196 N FEDERAL HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOCA RATON",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33431-6700",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-849-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/11/2025",
    "LastUpdateDate": "08/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "9120062",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "9120062",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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