Provider Demographics
NPI:1083403299
Name:SUKIJBUMRUNG, EMILIE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:SUKIJBUMRUNG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4325
Mailing Address - Country:US
Mailing Address - Phone:813-943-5708
Mailing Address - Fax:
Practice Address - Street 1:2005 PAN AM CIR STE 120
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2529
Practice Address - Country:US
Practice Address - Phone:813-434-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker