Healthcare Provider Details

I. General information

NPI: 1679794671
Provider Name (Legal Business Name): VATHANY SRIGANESHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2800
US

IV. Provider business mailing address

PO BOX 3093
BOCA RATON FL
33431-0993
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-3400
  • Fax: 305-535-3416
Mailing address:
  • Phone: 305-503-6320
  • Fax: 305-503-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME95975
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME95975
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME95975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: