Basic Information
| Provider Information | |||||||||
| NPI: | 1033413356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARAJA OF MIAMI LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 N BAYSHORE DR | ||||||||
| Address2: | APT 210 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331375108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059875140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 SW 62ND AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331553009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056666511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2010 | ||||||||
| LastUpdateDate: | 12/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | RAJADHYAKSHA | ||||||||
| AuthorizedOfficialFirstName: | APARNA | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3059875140 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | 105193 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 105193 | 01 | FL | STATE LICENSE | OTHER |