Healthcare Provider Details

I. General information

NPI: 1548585110
Provider Name (Legal Business Name): SHAIJI KARAKKUNNEL RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 NW 117TH AVE
CORAL SPRINGS FL
33071-4109
US

IV. Provider business mailing address

1045 NW 117TH AVE
CORAL SPRINGS FL
33071-4109
US

V. Phone/Fax

Practice location:
  • Phone: 954-753-9237
  • Fax:
Mailing address:
  • Phone: 954-753-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT10445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: