Provider Demographics
NPI:1972059038
Name:SOOKDEO, SHELBY LYNNE RANSDELL (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNNE RANSDELL
Last Name:SOOKDEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:LYNNE
Other - Last Name:RANSDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:135 BLACKSTONE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-3622
Mailing Address - Country:US
Mailing Address - Phone:719-205-5549
Mailing Address - Fax:
Practice Address - Street 1:1615 E STATE HIGHWAY 50
Practice Address - Street 2:SUITE 200
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-404-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116652363A00000X
COPA0004370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9116652OtherFLORIDA LICENSE
15907394OtherCAQH
1099163OtherNCCPA CERTIFICATION