MEDICARE: MISS SAYURI KITADA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1235607813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SAYURI KITADA

Provider Business Mailing Address
First Line	:	2800 SW 35TH PLACE
Second Line	:	APT #1201B
City	:	GAINESVILLE
State	:	FL
Zip	:	32608
Country	:	US
Telephone Number	:	813-606-3960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1908 STADIUM ROAD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32611
Country	:	US
Telephone Number	:	352-294-2925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	11/13/2018

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