Provider Demographics
NPI:1053883041
Name:BAYRASY, SUTHIDA
Entity type:Individual
Prefix:
First Name:SUTHIDA
Middle Name:
Last Name:BAYRASY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 4TH ST N APT 2113
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-2744
Mailing Address - Country:US
Mailing Address - Phone:727-600-0984
Mailing Address - Fax:
Practice Address - Street 1:7150 US 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4602
Practice Address - Country:US
Practice Address - Phone:727-803-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64109183700000X
FL37842183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician