Provider Demographics
NPI:1710513791
Name:SOOKDEO FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:SOOKDEO FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOOKDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-710-8646
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:407-395-2004
Mailing Address - Fax:
Practice Address - Street 1:14101 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4206
Practice Address - Country:US
Practice Address - Phone:863-937-6944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-21
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNY940OtherFL MEDICARE