Provider Demographics
NPI:1093958035
Name:DEARBORN DREAMS ANESTHESIA LLC
Entity Type:Organization
Organization Name:DEARBORN DREAMS ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SREENIVAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:VANGARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-843-9200
Mailing Address - Street 1:6094 14TH ST W
Mailing Address - Street 2:STE 128
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5515 GULF DR
Practice Address - Street 2:STE B
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4033
Practice Address - Country:US
Practice Address - Phone:727-843-9200
Practice Address - Fax:727-843-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty