Provider Demographics
NPI:1689893885
Name:KURIAKOSE, SUVY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUVY
Middle Name:
Last Name:KURIAKOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUVY
Other - Middle Name:
Other - Last Name:VATTASSERIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3090 CARUSO CT STE 50
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8510
Mailing Address - Country:US
Mailing Address - Phone:407-481-7179
Mailing Address - Fax:407-481-7190
Practice Address - Street 1:2731 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761
Practice Address - Country:US
Practice Address - Phone:407-635-3080
Practice Address - Fax:407-636-7804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243468207Q00000X
FLME111386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005483800Medicaid
FLFY582ZMedicare PIN