Provider Demographics
NPI:1194199364
Name:SHREE ANITHA PRASANNA PA
Entity type:Organization
Organization Name:SHREE ANITHA PRASANNA PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHREE
Authorized Official - Middle Name:ANITHA
Authorized Official - Last Name:PRASANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-268-0108
Mailing Address - Street 1:1490 CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6250
Mailing Address - Country:US
Mailing Address - Phone:321-267-3304
Mailing Address - Fax:321-267-9191
Practice Address - Street 1:1490 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6250
Practice Address - Country:US
Practice Address - Phone:321-267-3304
Practice Address - Fax:321-267-9191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty