Provider Demographics
NPI:1568684868
Name:VAKA, SUSMITHA (MD)
Entity type:Individual
Prefix:
First Name:SUSMITHA
Middle Name:
Last Name:VAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:2 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4753
Practice Address - Country:US
Practice Address - Phone:904-388-2619
Practice Address - Fax:904-388-0240
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60232871207RH0003X
FLME122164207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150VSOtherBC BS
FL383515OtherAVMED
FL015079800Medicaid
FL015079800Medicaid