Provider Demographics
NPI:1346806171
Name:ANKLE AND FOOT SPORTS MEDICINE INSTITUTE LLC
Entity type:Organization
Organization Name:ANKLE AND FOOT SPORTS MEDICINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMDATH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-279-0540
Mailing Address - Street 1:843 N WOODLAND BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2713
Mailing Address - Country:US
Mailing Address - Phone:386-279-0540
Mailing Address - Fax:386-279-0571
Practice Address - Street 1:843 N WOODLAND BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2713
Practice Address - Country:US
Practice Address - Phone:386-279-0540
Practice Address - Fax:386-279-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty