Provider Demographics
NPI:1679559512
Name:KUMAR, SUJATA (MD,)
Entity Type:Individual
Prefix:
First Name:SUJATA
Middle Name:
Last Name:KUMAR
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:PO BOX 48184
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0119
Mailing Address - Country:US
Mailing Address - Phone:813-371-0388
Mailing Address - Fax:
Practice Address - Street 1:15310 AMBERLY DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1642
Practice Address - Country:US
Practice Address - Phone:813-371-0388
Practice Address - Fax:813-371-0388
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80087208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259522200Medicaid