Provider Demographics
NPI:1740423656
Name:MILLER, SUKATI LEE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:SUKATI
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33870 BLUE STAR HWY APT 903
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2433
Mailing Address - Country:US
Mailing Address - Phone:315-395-9010
Mailing Address - Fax:
Practice Address - Street 1:33870 BLUE STAR HWY APT 903
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-2433
Practice Address - Country:US
Practice Address - Phone:315-395-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC132716R376K00000X
NY343453230813E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide