Provider Demographics
NPI:1255337382
Name:NATH, SUJAI DEEP (MD)
Entity type:Individual
Prefix:DR
First Name:SUJAI
Middle Name:DEEP
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:NATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 NW 13TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2269
Mailing Address - Country:US
Mailing Address - Phone:561-955-6663
Mailing Address - Fax:561-955-2879
Practice Address - Street 1:800 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2304
Practice Address - Country:US
Practice Address - Phone:561-955-4600
Practice Address - Fax:833-625-1604
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0332532084N0400X
CODR-481792084N0400X
SC335072084N0400X
FLME1053072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT033253OtherMEDICAL LICENSE
FL102318500Medicaid
FLPP528OtherMEDICARE PIN
CT010033253CT04OtherANTHEM BCBS
SCQ33253Medicaid