Provider Demographics
NPI:1851856975
Name:AKSHARBRAHMA PA
Entity Type:Organization
Organization Name:AKSHARBRAHMA PA
Other - Org Name:CHILDREN & FETAL HEART INSTITUTE OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:904-257-6264
Mailing Address - Street 1:6100 GREENLAND RD STE 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2626
Mailing Address - Country:US
Mailing Address - Phone:904-257-6264
Mailing Address - Fax:904-293-1326
Practice Address - Street 1:6100 GREENLAND RD STE 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2626
Practice Address - Country:US
Practice Address - Phone:904-257-6264
Practice Address - Fax:904-293-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-02
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102515700Medicaid
FL102213100Medicaid