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General NPI Number Information
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NPI Number | 1700172210
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Entity Type | Individual
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Provider Name | TRISHANNA CRYSTAL SOOKDEO M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 02/12/2021
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Provider Practice Location Address
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Address Line | 14101 W COLONIAL DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4206
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Country | US
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Telephone | 407-395-2004
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Fax | 407-395-2005
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 407-395-2004
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME125389
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License Number State | FL
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