Provider Demographics
NPI:1861852709
Name:SUCHITHRA HIRODE PH D LLC
Entity Type:Organization
Organization Name:SUCHITHRA HIRODE PH D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUCHITHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRODE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:813-400-2734
Mailing Address - Street 1:13035 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4481
Mailing Address - Country:US
Mailing Address - Phone:813-400-2734
Mailing Address - Fax:813-313-9499
Practice Address - Street 1:9643 GRETNA GREEN DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:813-313-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8814174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty