Provider Demographics
NPI:1699074476
Name:SAIKIA, SUROBHI (MA,,)
Entity type:Individual
Prefix:MRS
First Name:SUROBHI
Middle Name:
Last Name:SAIKIA
Suffix:
Gender:F
Credentials:MA,,
Other - Prefix:MISS
Other - First Name:SUROBHI
Other - Middle Name:
Other - Last Name:BORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSC
Mailing Address - Street 1:2687 TRAILS AT HIDDEN HBR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4163
Mailing Address - Country:US
Mailing Address - Phone:321-454-4356
Mailing Address - Fax:
Practice Address - Street 1:2687 TRAILS AT HIDDEN HBR
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4163
Practice Address - Country:US
Practice Address - Phone:321-454-4356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-20
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1057103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool