Provider Demographics
NPI:1801252820
Name:SUKHRAJ, SURESH
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:SUKHRAJ
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 1:6979 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-8207
Mailing Address - Country:US
Mailing Address - Phone:844-201-9009
Mailing Address - Fax:844-656-1444
Practice Address - Street 1:6979 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-8207
Practice Address - Country:US
Practice Address - Phone:844-201-9009
Practice Address - Fax:844-656-1444
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies