Provider Demographics
NPI:1154934826
Name:SURA, JOSEPH RONALD
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RONALD
Last Name:SURA
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 1:154 CUNNINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043-4837
Mailing Address - Country:US
Mailing Address - Phone:231-557-5861
Mailing Address - Fax:
Practice Address - Street 1:154 CUNNINGHAM LN
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043-4837
Practice Address - Country:US
Practice Address - Phone:231-557-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool