Provider Demographics
NPI:1578188132
Name:SULE, MANASI (MD)
Entity Type:Individual
Prefix:
First Name:MANASI
Middle Name:
Last Name:SULE
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 1:206 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4902
Mailing Address - Country:US
Mailing Address - Phone:863-209-7003
Mailing Address - Fax:863-274-3520
Practice Address - Street 1:206 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4902
Practice Address - Country:US
Practice Address - Phone:863-209-7003
Practice Address - Fax:863-274-3520
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-06-21
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-02-03
Provider Licenses
StateLicense IDTaxonomies
FLME159295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine