Provider Demographics
NPI:1376812503
Name:SUKHADIA, VINIT
Entity Type:Individual
Prefix:
First Name:VINIT
Middle Name:
Last Name:SUKHADIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 RANTOUL LN
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4249
Mailing Address - Country:US
Mailing Address - Phone:407-688-4646
Mailing Address - Fax:
Practice Address - Street 1:1201 S INTERNATIONAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1615
Practice Address - Country:US
Practice Address - Phone:407-805-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist