Healthcare Provider Details

I. General information

NPI: 1952335564
Provider Name (Legal Business Name): SISHNARINE DIANAND RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 US HIGHWAY 27 S
SEBRING FL
33870-4920
US

IV. Provider business mailing address

PO BOX 8135
SEBRING FL
33872-0119
US

V. Phone/Fax

Practice location:
  • Phone: 863-386-1599
  • Fax: 863-386-1699
Mailing address:
  • Phone: 863-386-1599
  • Fax: 863-386-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberRT4983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: