Provider Demographics
NPI:1891374484
Name:BALAKRISHNAN, EASON
Entity Type:Individual
Prefix:
First Name:EASON
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 NW 64TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4218
Mailing Address - Country:US
Mailing Address - Phone:352-333-5980
Mailing Address - Fax:352-376-4975
Practice Address - Street 1:7485 SW 17TH RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-1000
Practice Address - Country:US
Practice Address - Phone:352-333-5700
Practice Address - Fax:352-333-4976
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program