Provider Demographics
NPI:1538145602
Name:NEERUKONDA, SUHAS P (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:P
Last Name:NEERUKONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 PLANTATION ISLAND DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:904-461-0821
Mailing Address - Fax:904-461-0823
Practice Address - Street 1:1301 PLANTATION ISLAND DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080
Practice Address - Country:US
Practice Address - Phone:904-461-0821
Practice Address - Fax:904-461-0823
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2024-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 78969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257641400Medicaid
FL49308OtherBCBS
H05851Medicare UPIN
FL257641400Medicaid