Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XF0002X | Feeding, Eating & Swallowing | OTA12298 | FL |
NPI | 1104398692 |
---|---|
Provider Name | Suveshen Naidoo |
First Address | Wellington, FL 33414-5620 |
Second Address | Wellington, FL 33414-5620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2018 |