Provider Demographics
NPI:1194339986
Name:EDMOND, SUKI LAQUITA
Entity type:Individual
Prefix:
First Name:SUKI
Middle Name:LAQUITA
Last Name:EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 CANDLELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4769
Mailing Address - Country:US
Mailing Address - Phone:757-420-2870
Mailing Address - Fax:
Practice Address - Street 1:2004 CANDLELIGHT DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-4769
Practice Address - Country:US
Practice Address - Phone:757-714-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health