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General NPI Number Information
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NPI Number | 1952192247
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Entity Type | Individual
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Provider Name | ASHA THEVARANJAN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 1650 N PARK AVE
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City | MAITLAND
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State | FL
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Zip | 32751-6570
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Country | US
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Telephone | 407-647-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 150 ESSEX DR
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City | LONGWOOD
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State | FL
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Zip | 32779-5744
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Country | US
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Telephone | 315-884-0149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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