Provider Demographics
NPI:1801570619
Name:SURIAKUMARAN, BALAKUMARAN
Entity type:Individual
Prefix:
First Name:BALAKUMARAN
Middle Name:
Last Name:SURIAKUMARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 OLD CANOE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-7670
Mailing Address - Country:US
Mailing Address - Phone:407-593-1242
Mailing Address - Fax:
Practice Address - Street 1:2910 OLD CANOE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-7670
Practice Address - Country:US
Practice Address - Phone:407-593-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility