Provider Demographics
NPI:1780878413
Name:KAUSHALENDRA K SINGH MD PA
Entity type:Organization
Organization Name:KAUSHALENDRA K SINGH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-227-6768
Mailing Address - Street 1:PO BOX 330196
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-0196
Mailing Address - Country:US
Mailing Address - Phone:386-866-9095
Mailing Address - Fax:877-346-1184
Practice Address - Street 1:700 ZEAGLER DR STE 8
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3826
Practice Address - Country:US
Practice Address - Phone:386-866-9095
Practice Address - Fax:877-346-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45411OtherBCBS GROUP NUMBER
FLK1153Medicare PIN