Provider Demographics
NPI:1639795388
Name:SUCHER, KINSEY DREA
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:DREA
Last Name:SUCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-3556
Mailing Address - Country:US
Mailing Address - Phone:407-533-2696
Mailing Address - Fax:
Practice Address - Street 1:1510 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3556
Practice Address - Country:US
Practice Address - Phone:407-533-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS260504957990374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374J00000XMedicaid