Healthcare Provider Details

I. General information

NPI: 1306429683
Provider Name (Legal Business Name): JONATHAN SATYA KANAKARAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

IV. Provider business mailing address

1851 NW 10TH AVE
MIAMI FL
33136-1054
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9783
  • Fax:
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number175600
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number175600
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number0116035738
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number0116035738
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number0116035738
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number175600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: