Provider Demographics
NPI:1922080043
Name:SUKUMAR, DEEPA (MD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:SUKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 S SEMORAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2472
Mailing Address - Country:US
Mailing Address - Phone:407-203-8957
Mailing Address - Fax:855-296-8047
Practice Address - Street 1:4445 S SEMORAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2472
Practice Address - Country:US
Practice Address - Phone:407-203-8957
Practice Address - Fax:855-296-8047
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122569208000000X
NY002380208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016837800Medicaid
NY02709295Medicaid
FL016837800Medicaid
NY02709295Medicaid