Provider Demographics
NPI:1417021783
Name:PUSKUR, SUSHIL RAO (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:RAO
Last Name:PUSKUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SE 18TH ST STE 802
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5447
Mailing Address - Country:US
Mailing Address - Phone:352-369-3100
Mailing Address - Fax:352-369-3101
Practice Address - Street 1:1740 SE 18TH ST STE 802
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5447
Practice Address - Country:US
Practice Address - Phone:352-369-3100
Practice Address - Fax:352-369-3101
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME999632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000288400Medicaid