Individual
SUSMITHA VAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 SHIRCLIFF WAY, SUITE 800, JACKSONVILLE, FL 32204-4753
(904) 388-2619
(904) 388-0240
Mailing address
7015 A C SKINNER PKWY, SUITE 1, JACKSONVILLE, FL 32256-6932
(904) 363-2113
(904) 363-2606
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
MD60232871
WA
207RH0003X
Hematology & Oncology Physician
Primary
ME122164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015079800
—
FL
01
—
150VS
BC BS
FL
01
—
383515
AVMED
FL
Enumeration date
05/03/2007
Last updated
09/10/2015
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