Healthcare Provider Details

I. General information

NPI: 1902934508
Provider Name (Legal Business Name): BHAGIRATHY SAHASRANAMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W PROSPECT RD
FORT LAUDERDALE FL
33309-2519
US

IV. Provider business mailing address

2900 W. PROSPECT ROAD
FORT LAUDERDALE FL
33309
US

V. Phone/Fax

Practice location:
  • Phone: 954-731-5100
  • Fax:
Mailing address:
  • Phone: 954-731-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0048631
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0048631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: