Healthcare Provider Details

I. General information

NPI: 1164083564
Provider Name (Legal Business Name): SHREE ANITHA PRASANNA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PINEDA PLAZA WAY
MELBOURNE FL
32940-7318
US

IV. Provider business mailing address

2955 PINEDA PLAZA WAY STE 108
MELBOURNE FL
32940-7306
US

V. Phone/Fax

Practice location:
  • Phone: 321-267-3304
  • Fax:
Mailing address:
  • Phone: 321-267-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SHREE PRASANA
Title or Position: OWNER
Credential:
Phone: 321-267-3304