Provider Demographics
NPI:1164083564
Name:SHREE ANITHA PRASANNA PA INC
Entity Type:Organization
Organization Name:SHREE ANITHA PRASANNA PA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-267-3304
Mailing Address - Street 1:2955 PINEDA PLAZA WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7306
Mailing Address - Country:US
Mailing Address - Phone:321-267-3304
Mailing Address - Fax:
Practice Address - Street 1:2955 PINEDA PLAZA WAY
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7318
Practice Address - Country:US
Practice Address - Phone:321-267-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment