Healthcare Provider Details

I. General information

NPI: 1194930412
Provider Name (Legal Business Name): APARNA RAJADHAYAKSHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVENUE DEPT OF GENETICS
MIAMI FL
33155-1005
US

IV. Provider business mailing address

3801 COLLINS AVE APT 1503
MIAMI BEACH FL
33140-3705
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax:
Mailing address:
  • Phone: 305-987-5140
  • Fax: 305-243-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME105193
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberME105193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: