Provider Demographics
NPI:1326260126
Name:ANASSERI, SHIVA
Entity Type:Individual
Prefix:MRS
First Name:SHIVA
Middle Name:
Last Name:ANASSERI
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 1:430 S DIXIE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2200
Mailing Address - Country:US
Mailing Address - Phone:305-740-0740
Mailing Address - Fax:
Practice Address - Street 1:430 S DIXIE HWY STE 210
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2200
Practice Address - Country:US
Practice Address - Phone:305-740-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1002208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice