Provider Demographics
NPI:1639266984
Name:MUNUSWAMY, SARITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARITA
Middle Name:
Last Name:MUNUSWAMY
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 1:1600 NORTH FEDERAL HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062
Mailing Address - Country:US
Mailing Address - Phone:954-785-6343
Mailing Address - Fax:954-785-4322
Practice Address - Street 1:1600 NORTH FEDERAL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062
Practice Address - Country:US
Practice Address - Phone:954-785-6343
Practice Address - Fax:954-785-4322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068032000Medicaid
FL94212Medicare ID - Type UnspecifiedMEDICARE
FL068032000Medicaid