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NPI Code Detail

MEDICARE: DANIELLE SOOKOOR PA

MEDICARE:   DANIELLE  SOOKOOR  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA9107755FL

General Provider Information

NPI Number : 1811311905
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE SOOKOOR PA
Provider Business Mailing Address
First Line : 4401 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-3142
Country : US
Telephone Number : 941-357-5550
Fax Number :
Provider Business Practice Location Address
First Line : 4401 CORTEZ RD W
Second Line :
City : BRADENTON
State : FL
Zip : 34210-3142
Country : US
Telephone Number : 941-357-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2014
Last Update Date : 02/10/2014

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Directions to “ DANIELLE SOOKOOR PA” Practice Location

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