MEDICARE: ANIL SUTHAR LMT

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
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	SELF	OTHER		SELF

General Provider Information

NPI Number	:	1831700848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIL SUTHAR LMT

Provider Business Mailing Address
First Line	:	11776 WATTLE TREE RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9751
Country	:	US
Telephone Number	:	904-955-3029
Fax Number	:

Provider Business Practice Location Address
First Line	:	11776 WATTLE TREE RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-9751
Country	:	US
Telephone Number	:	904-955-3029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	08/12/2020

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Directions to “ ANIL SUTHAR LMT” Practice Location

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