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General NPI Number Information
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NPI Number | 1417021783
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Entity Type | Individual
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Provider Name | SUSHIL RAO PUSKUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 1740 SE 18TH ST STE 802
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City | OCALA
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State | FL
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Zip | 34471-5447
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Country | US
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Telephone | 352-369-3100
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Fax | 352-369-3101
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Provider Business Mailing Address
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Address Line | 1740 SE 18TH ST STE 802
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City | OCALA
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State | FL
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Zip | 34471-5447
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Country | US
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Telephone | 352-369-3100
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Fax | 352-369-3101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME99963
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License Number State | FL
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