1548532559 NPI number — SATIE KALLICHARAN PA-C

Table of content: SATIE KALLICHARAN PA-C (NPI 1548532559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548532559 NPI number — SATIE KALLICHARAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALLICHARAN
Provider First Name:
SATIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548532559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7800 W OAKLAND PARK BLVD
Provider Second Line Business Mailing Address:
SUITE E-214
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33351-6741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-318-6590
Provider Business Mailing Address Fax Number:
954-318-6604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7401 N. UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-722-0130
Provider Business Practice Location Address Fax Number:
954-722-0132
Provider Enumeration Date:
02/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9106189 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111058800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com