Provider Demographics
NPI:1831852656
Name:PERSAUD, CHANDREKAR
Entity type:Individual
Prefix:MR
First Name:CHANDREKAR
Middle Name:
Last Name:PERSAUD
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 1:419 RYANS RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6454
Mailing Address - Country:US
Mailing Address - Phone:301-437-5163
Mailing Address - Fax:
Practice Address - Street 1:419 RYANS RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6454
Practice Address - Country:US
Practice Address - Phone:301-437-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL873127780OtherALL INSURANCES AND PRIVATE CLIENTS
FL873127780Medicaid