Provider Demographics
NPI:1316941354
Name:KRISHNADAS, RANJEETA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RANJEETA
Middle Name:
Last Name:KRISHNADAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 MEDICAL WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5412
Mailing Address - Country:US
Mailing Address - Phone:863-382-0566
Mailing Address - Fax:863-471-9340
Practice Address - Street 1:3201 MEDICAL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5412
Practice Address - Country:US
Practice Address - Phone:863-382-0566
Practice Address - Fax:863-471-9340
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013849200Medicaid