Provider Demographics
NPI:1619975562
Name:PRADHAN, ANUJA SANDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUJA
Middle Name:SANDEEP
Last Name:PRADHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2043
Mailing Address - Country:US
Mailing Address - Phone:727-725-8102
Mailing Address - Fax:727-796-7009
Practice Address - Street 1:3253 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2043
Practice Address - Country:US
Practice Address - Phone:727-725-8102
Practice Address - Fax:727-796-7009
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88854207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI00679Medicare UPIN
FL37374ZMedicare ID - Type Unspecified