Provider Demographics
NPI:1013491380
Name:SOOKOOR, BASDAI SIRJU (RN, CCM)
Entity Type:Individual
Prefix:MS
First Name:BASDAI
Middle Name:SIRJU
Last Name:SOOKOOR
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 MALLORY SAIL PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2387
Mailing Address - Country:US
Mailing Address - Phone:813-727-7131
Mailing Address - Fax:
Practice Address - Street 1:1420 MALLORY SAIL PL
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2387
Practice Address - Country:US
Practice Address - Phone:813-727-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9216102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management