Provider Demographics
NPI:1053883041
Name:BAYRASY, SUTHIDA
Entity type:Individual
Prefix:
First Name:SUTHIDA
Middle Name:
Last Name:BAYRASY
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 1:306 S WESTLAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1802
Mailing Address - Country:US
Mailing Address - Phone:727-600-0984
Mailing Address - Fax:
Practice Address - Street 1:3801 CORPOREX PARK DR STE 115
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1179
Practice Address - Country:US
Practice Address - Phone:727-803-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2025-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37842183700000X
FLPS629891835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No183700000XPharmacy Service ProvidersPharmacy Technician