Provider Demographics
NPI:1457822066
Name:POORANSINGH, SURUJDAI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SURUJDAI
Middle Name:
Last Name:POORANSINGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 AYLESBURY CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4298
Mailing Address - Country:US
Mailing Address - Phone:407-319-0470
Mailing Address - Fax:
Practice Address - Street 1:354 AYLESBURY CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4298
Practice Address - Country:US
Practice Address - Phone:407-319-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2018078389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine