Provider Demographics
NPI:1063478345
Name:BEECUM, SUSHILLA N (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHILLA
Middle Name:N
Last Name:BEECUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 54TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709
Mailing Address - Country:US
Mailing Address - Phone:727-544-7766
Mailing Address - Fax:727-544-1300
Practice Address - Street 1:7000 54TH AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-544-7766
Practice Address - Fax:727-544-1300
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0039269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042925200Medicaid
FLD85778Medicare UPIN
FL47593Medicare ID - Type Unspecified