Individual
ACKSA CHACKO KUCHARYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1314 OAK ST, MELBOURNE, FL 32901-3111
(321) 727-7992
Mailing address
1314 OAK ST, MELBOURNE, FL 32901
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601006555
MI
363A00000X
Physician Assistant
PA9110285
FL
363AM0700X
Medical Physician Assistant
Primary
PA9110285
FL
Other
Enumeration date
01/22/2013
Last updated
01/21/2025
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