Healthcare Provider Details

I. General information

NPI: 1396368874
Provider Name (Legal Business Name): DEEPIKA RATNALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N FEDERAL HWY STE 200
FT LAUDERDALE FL
33308-4609
US

IV. Provider business mailing address

4750 N FEDERAL HWY STE 200
FT LAUDERDALE FL
33308-4609
US

V. Phone/Fax

Practice location:
  • Phone: 954-561-3338
  • Fax:
Mailing address:
  • Phone: 954-561-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP04418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: