Provider Demographics
NPI:1285079780
Name:DASRATH, SHANIE (MOT, OTD, OTRL, LMT)
Entity type:Individual
Prefix:DR
First Name:SHANIE
Middle Name:
Last Name:DASRATH
Suffix:
Gender:F
Credentials:MOT, OTD, OTRL, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 SW 91ST DR STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9117
Mailing Address - Country:US
Mailing Address - Phone:352-235-9471
Mailing Address - Fax:
Practice Address - Street 1:5208 SW 91ST DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3006
Practice Address - Country:US
Practice Address - Phone:386-965-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2024-06-12
Deactivation Date:2018-09-23
Deactivation Code:
Reactivation Date:2020-06-25
Provider Licenses
StateLicense IDTaxonomies
FLMA98457225700000X
FL12761225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist