Provider Demographics
NPI:1518921865
Name:RAZDAN, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:RAZDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 NW 82ND AVE STE PH501
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6658
Mailing Address - Country:US
Mailing Address - Phone:305-251-8650
Mailing Address - Fax:305-251-8913
Practice Address - Street 1:3650 NW 82ND AVE STE PH501
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6658
Practice Address - Country:US
Practice Address - Phone:305-251-8650
Practice Address - Fax:305-251-8913
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81109208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL246000OtherSTAYWELL
FL271022600Medicaid
FL44003OtherBCBS
FL246000OtherWELLCARE
FL7235637OtherAETNA
FLP00419005OtherRAILROAD MEDICARE
FL295363OtherAVMED
FL44003OtherBCBS
FL400001160000OtherPREFERRED CARE PARTNERS
FL051119OtherNHP
FL400001160000OtherPREFERRED CARE PARTNERS
FL271022600Medicaid