Trysari Sudiro

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95018240 Issued in CA

Practice address

2810 Long Beach Blvd
Long Beach, CA 90806-1558

Phone

(626) 709-7802

NPI assigned

Apr 19, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Trysari Chandra Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1396432399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 LONG BEACH BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061558",
            "telephone_number": "626-709-7802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 LONG BEACH BLVD",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061558",
            "telephone_number": "626-709-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDIRO",
        "first_name": "TRYSARI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95018240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRYSARI",
            "last_name": "CHANDRA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jasmin Suayan
• Alejandra Josmary Suazo, LCSW118958
• Sofia Subhan
• Nabil Subhani, OD
• Substance Abuse Foundation of Long Beach
• Raymond Nathan Sue-Seto
• Travis Sue
• Julie Sugarman
• Laquita Shanta Suggs, LCSW
• Cheryl Ann Suing, L.AC.

• Acute Care Nurse Practitioner in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.