Provider Demographics
NPI:1851564819
Name:SINGH, SUROJDIAL (PA)
Entity Type:Individual
Prefix:MR
First Name:SUROJDIAL
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SAXON BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8313
Mailing Address - Country:US
Mailing Address - Phone:386-774-1881
Mailing Address - Fax:386-774-1264
Practice Address - Street 1:926 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8313
Practice Address - Country:US
Practice Address - Phone:386-774-1881
Practice Address - Fax:386-774-1264
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical