Provider Demographics
NPI:1619023470
Name:KUMAR, PRECY P (MMS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PRECY
Middle Name:P
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:600 N HIATUS RD
Practice Address - Street 2:SUITE 215
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5207
Practice Address - Country:US
Practice Address - Phone:954-437-3600
Practice Address - Fax:954-437-8251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103463207K00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000590000Medicaid
FLBJ793YOtherMEDICARE
FLBJ793ZOtherMEDICARE