Provider Demographics
NPI:1629065461
Name:WATANE, ARCHANA ANAND (MD)
Entity Type:Individual
Prefix:MRS
First Name:ARCHANA
Middle Name:ANAND
Last Name:WATANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 WEST OAK STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741
Mailing Address - Country:US
Mailing Address - Phone:407-846-3455
Mailing Address - Fax:407-846-3670
Practice Address - Street 1:801 WEST OAK STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741
Practice Address - Country:US
Practice Address - Phone:407-846-3455
Practice Address - Fax:407-846-3670
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME81169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263879700Medicaid