Provider Demographics
NPI:1225262272
Name:SUJANANI, VISHNU HARDASMAL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:VISHNU
Middle Name:HARDASMAL
Last Name:SUJANANI
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:10735 NORTHRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5041
Mailing Address - Country:US
Mailing Address - Phone:727-376-9180
Mailing Address - Fax:727-376-9180
Practice Address - Street 1:10735 NORTHRIDGE CT
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5041
Practice Address - Country:US
Practice Address - Phone:727-376-9180
Practice Address - Fax:727-376-9180
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH221AOtherMEDICARE