Provider Demographics
NPI:1952192247
Name:THEVARANJAN, ASHA
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:THEVARANJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5744
Mailing Address - Country:US
Mailing Address - Phone:315-884-0149
Mailing Address - Fax:
Practice Address - Street 1:1650 N PARK AVE
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6570
Practice Address - Country:US
Practice Address - Phone:407-647-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program