Provider Demographics
NPI:1922516541
Name:KESARI, AKASH
Entity Type:Individual
Prefix:
First Name:AKASH
Middle Name:
Last Name:KESARI
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 1:411 N DONNELLY ST STE 307
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5596
Mailing Address - Country:US
Mailing Address - Phone:352-720-5172
Mailing Address - Fax:407-386-7133
Practice Address - Street 1:411 N DONNELLY ST STE 307
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5596
Practice Address - Country:US
Practice Address - Phone:352-720-5172
Practice Address - Fax:407-386-7133
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-8349-81340106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician