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General NPI Number Information
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NPI Number | 1891817029
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Entity Type | Organization
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Legal Business Name | AKSHAYA BALAJI LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1900 N ATLANTIC AVE UNIT 1602
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-8312
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Country | US
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Telephone | 407-285-5956
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Fax | 321-339-1949
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Provider Business Mailing Address
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Address Line | 1900 N ATLANTIC AVE UNIT 1602
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-8312
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Country | US
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Telephone | 407-285-5956
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Fax | 321-339-1949
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAVI NAGARAJAN
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Credential |
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Telephone | 407-360-1742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 72472
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License Number State | FL
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