Healthcare Provider Details

I. General information

NPI: 1588285753
Provider Name (Legal Business Name): ANURADHA RAMPERSAUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20814 W DIXIE HWY
AVENTURA FL
33180-1147
US

IV. Provider business mailing address

20814 W DIXIE HWY
AVENTURA FL
33180-1147
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-8433
  • Fax: 305-933-9115
Mailing address:
  • Phone: 305-933-8433
  • Fax: 305-933-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115131
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: