Provider Demographics
NPI:1538208418
Name:SUDARSKY, LAURA A (M D)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:SUDARSKY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4125
Mailing Address - Country:US
Mailing Address - Phone:954-533-1671
Mailing Address - Fax:954-337-3309
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-533-1671
Practice Address - Fax:954-337-3309
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16364412082S0105X
FLME95533208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62444Medicare UPIN
NY63F461Medicare ID - Type Unspecified