Provider Demographics
NPI:1962707174
Name:SUDHIR K NAYER MD & ASSOC PA
Entity type:Organization
Organization Name:SUDHIR K NAYER MD & ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHIR
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-879-0008
Mailing Address - Street 1:8501 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3346
Mailing Address - Country:US
Mailing Address - Phone:772-879-0008
Mailing Address - Fax:772-879-4504
Practice Address - Street 1:8501 S US HIGHWAY 1
Practice Address - Street 2:SUITE 10
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3346
Practice Address - Country:US
Practice Address - Phone:772-879-0008
Practice Address - Fax:772-879-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20859261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055021300Medicaid
FL055021300Medicaid