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General NPI Number Information
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NPI Number | 1194199364
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Entity Type | Organization
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Legal Business Name | SHREE ANITHA PRASANNA PA
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Dates
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Enumeration Date | 11/25/2015
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1490 CHENEY HWY
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City | TITUSVILLE
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State | FL
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Zip | 32780-6250
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Country | US
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Telephone | 321-267-3304
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Fax | 321-267-9191
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Provider Business Mailing Address
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Address Line | 1490 CHENEY HWY
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City | TITUSVILLE
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State | FL
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Zip | 32780-6250
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Country | US
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Telephone | 321-267-3304
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Fax | 321-267-9191
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Authorized Official
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Title or Position | ADMINISTRATOR OFFICER
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Name | SHREE ANITHA PRASANNA
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Credential |
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Telephone | 321-268-0108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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