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1164480745

NPI Code Detail

MEDICARE: DR. REKHA PRASAD MD

MEDICARE: DR. REKHA PRASAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2004022183	MO
2	2084P0800X	Psychiatry Physician	0429862	KS
3	2084P0804X	Child & Adolescent Psychiatry Physician	82623	SC
4	2084P0804X	Child & Adolescent Psychiatry Physician	ME111485	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164480745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REKHA PRASAD MD

Provider Business Mailing Address
First Line	:	841 JIMMY ANN DR
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4583
Country	:	US
Telephone Number	:	386-274-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 JIMMY ANN DR
Second Line	:	HALIFAX BEHAVIORAL SERVICES
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-4583
Country	:	US
Telephone Number	:	386-274-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/05/2019

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841 JIMMY ANN DR
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32117-4583

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1538389374 — DEBBIE BUTLER EDWARDS
Practice Location Address:

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DAYTONA BEACH, FL
32117-4583

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1780855049 — FELICIA WALKER CASE MANAGER
Practice Location Address:

841 JIMMY ANN DRIVE , HALIFAX BEHAVIORAL SERVICES
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1750511515 — MS. MELANIE SMITH PHD, LMHC
Practice Location Address:

841 JIMMY ANN DR
DAYTONA BEACH, FL
32117-4583

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Practice Fax:

1801125638 — MRS. KIMBERLY S JACKSON MSW
Practice Location Address:

841 JIMMY ANN DR
DAYTONA BEACH, FL
32117-4583

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Directions to “ DR. REKHA PRASAD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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