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General NPI Number Information
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NPI Number | 1427253525
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Entity Type | Individual
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Provider Name | SUSHEELA RAVINDRA NATHAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14555 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6003
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Country | US
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Telephone | 352-796-6000
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Fax | 305-667-0239
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Provider Business Mailing Address
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Address Line | 5901 SW 74TH ST SUITE 202
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City | MIAMI
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State | FL
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Zip | 33143-5165
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Country | US
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Telephone | 305-665-4614
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Fax | 305-667-0239
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | ME 27079
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License Number State | FL
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