Provider Demographics
NPI:1326022427
Name:PACHAIDEE, SUKANYA (MD)
Entity Type:Individual
Prefix:
First Name:SUKANYA
Middle Name:
Last Name:PACHAIDEE
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-676-6322
Mailing Address - Fax:321-722-1879
Practice Address - Street 1:205 E NASA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1950
Practice Address - Country:US
Practice Address - Phone:321-676-6322
Practice Address - Fax:321-722-1879
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90829207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00144837OtherRR MEDICARE
FL270174000Medicaid
I13079Medicare UPIN
FL270174000Medicaid