Provider Demographics
NPI:1972916484
Name:PERSAUD, RAVINDRA (CSA LSA)
Entity Type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:CSA LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3543 SHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-8660
Mailing Address - Country:US
Mailing Address - Phone:470-295-7782
Mailing Address - Fax:
Practice Address - Street 1:3543 SHAWN ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-8660
Practice Address - Country:US
Practice Address - Phone:470-295-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3858246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant