Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 107122 | FL |
Y | 208200000X | Surgeon | 107122 | FL |
Y | 208600000X | Surgeon | 107122 | FL |
N | 208200000X | Surgeon | 35088257 | OH |
N | 208600000X | Surgeon | 35088257 | OH |
NPI | 1598770430 |
---|---|
Provider Name | Shashidhar Kusuma |
First Address | Plantation, FL 33324-2700 |
Second Address | Plantation, FL 33324-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2670104 | (05) | OH |
I55371 | (02) | OH |