Provider Demographics
NPI:1629657598
Name:CRAG-CHADERTON, RAYKHA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RAYKHA
Middle Name:
Last Name:CRAG-CHADERTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RAYKHA
Other - Middle Name:
Other - Last Name:SASENARINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:560 LEGACY PARK DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-2402
Mailing Address - Country:US
Mailing Address - Phone:407-257-4857
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-257-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011731363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health