Provider Demographics
NPI:1528786019
Name:PERSAUD, KESHEA
Entity type:Individual
Prefix:
First Name:KESHEA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 ALTAMIRA CIR APT 308
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4029
Mailing Address - Country:US
Mailing Address - Phone:347-530-7886
Mailing Address - Fax:321-972-1308
Practice Address - Street 1:671 ALTAMIRA CIR APT 308
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4029
Practice Address - Country:US
Practice Address - Phone:347-530-7886
Practice Address - Fax:321-972-1308
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL343900000X
FLP623-500-89-916-0343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)