Provider Demographics
NPI:1871787036
Name:NAKKA, SUSHMA SIMHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHMA
Middle Name:SIMHA
Last Name:NAKKA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3525 LAKELAND HILLS BLVD
Practice Address - Street 2:LAKELAND REGIONAL CANCER CENTER
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1965
Practice Address - Country:US
Practice Address - Phone:863-603-6565
Practice Address - Fax:863-603-6564
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
NY228988207RH0003X
FLME102036207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL000250700Medicaid
FLME102036OtherSTATE LIC
FLAL353ZMedicare PIN
FL1497748743OtherGROUP NPI NUMBER
05659800OtherECFMG