Provider Demographics
NPI:1720752926
Name:ROOP, ANASTASIA (MED)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ROOP
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-3371
Mailing Address - Country:US
Mailing Address - Phone:321-805-4426
Mailing Address - Fax:
Practice Address - Street 1:816 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3371
Practice Address - Country:US
Practice Address - Phone:321-805-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR100016888050Medicaid