Organization
GRACEMDCONNECT
Active
Parent organization
GRACE MED PA
Other names
GRACEMDCONNECT
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRACE MED PA
Authorized official
DR. DEEPA SUKUMAR MD (PRESIDENT)
(718) 344-7062
Entity
Organization
Contact information
Practice address
11934 ANGLE POND AVE, WINDERMERE, FL 34786-6526
(718) 344-7062
Mailing address
11934 ANGLE POND AVE, WINDERMERE, FL 34786-6526
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME122569
FL
Other
Enumeration date
03/07/2018
Last updated
03/07/2018
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