Provider Demographics
NPI:1669152963
Name:SUKHRAJ, UMAWATTIE
Entity type:Individual
Prefix:
First Name:UMAWATTIE
Middle Name:
Last Name:SUKHRAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 SE WALD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4739
Mailing Address - Country:US
Mailing Address - Phone:772-812-4475
Mailing Address - Fax:
Practice Address - Street 1:10026 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5625
Practice Address - Country:US
Practice Address - Phone:772-812-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies