Provider Demographics
NPI:1881393304
Name:SURESH, RAJALAKSHMI (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RAJALAKSHMI
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:RAJALAKSHMI
Other - Middle Name:
Other - Last Name:PARAMESWARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7369 SHERIDAN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2776
Mailing Address - Country:US
Mailing Address - Phone:954-369-4111
Mailing Address - Fax:954-350-0909
Practice Address - Street 1:7369 SHERIDAN ST STE 203
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2776
Practice Address - Country:US
Practice Address - Phone:954-369-4111
Practice Address - Fax:954-350-0909
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019641363LP0808X
FLAPRN11024854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119729900Medicaid