Provider Demographics
NPI:1528453438
Name:PERSAD, AVINASH (DO)
Entity type:Individual
Prefix:
First Name:AVINASH
Middle Name:
Last Name:PERSAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3763
Mailing Address - Country:US
Mailing Address - Phone:954-217-3220
Mailing Address - Fax:
Practice Address - Street 1:9750 NW 33RD ST STE 220
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4081
Practice Address - Country:US
Practice Address - Phone:954-217-3220
Practice Address - Fax:954-217-6111
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015039000Medicaid
FL150EZOtherFL BLUE
FLIG228ZMedicare PIN