Provider Demographics
NPI:1790009819
Name:CHAUDHARI, SURESH
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:
Last Name:CHAUDHARI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SURESH
Other - Middle Name:
Other - Last Name:CHAUDHARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:6750 PENZANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8351
Mailing Address - Country:US
Mailing Address - Phone:239-560-4354
Mailing Address - Fax:239-368-3091
Practice Address - Street 1:4861 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6953
Practice Address - Country:US
Practice Address - Phone:239-560-4354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001277100Medicaid