Healthcare Provider Details

I. General information

NPI: 1881872877
Provider Name (Legal Business Name): PRC ASSOCIATES, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 DUNLAWTON AVE SUITE D
PORT ORANGE FL
32127-9279
US

IV. Provider business mailing address

1671 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32117-5590
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-2977
  • Fax: 386-274-2966
Mailing address:
  • Phone: 386-274-2977
  • Fax: 386-274-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SANJAY BAKSHI
Title or Position: OWNER
Credential: M.D.
Phone: 386-274-2977