Provider Demographics
NPI:1578292322
Name:AMBERPET Y. RATHNAM, M.D., P.A.
Entity Type:Organization
Organization Name:AMBERPET Y. RATHNAM, M.D., P.A.
Other - Org Name:SUNSHINE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBERPET
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RATHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-572-7755
Mailing Address - Street 1:6765 SUNSET STRIP STE 6 &7
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2894
Mailing Address - Country:US
Mailing Address - Phone:954-572-7755
Mailing Address - Fax:954-572-7799
Practice Address - Street 1:6765 SUNSET STRIP STE 6&7
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33313-2894
Practice Address - Country:US
Practice Address - Phone:954-572-7755
Practice Address - Fax:954-572-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119339300Medicaid