# VASANA CHEANVECHAI MD, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457773210
- **Authorized official:** MS. STEPHANIE C DAVES (OFFICE MANAGER)
- **Authorized official phone:** (330) 563-0617

## Contact information

- **Practice address:** 4800 NE 20TH TER, STE 109, FT LAUDERDALE, FL 33308-4510
- **Practice address phone:** (954) 338-3021
- **Practice address fax:** (330) 563-0604
- **Mailing address:** 4800 NE 20TH TER, STE 109, FT LAUDERDALE, FL 33308-4510
- **Mailing address phone:** (954) 338-3021
- **Mailing address fax:** (330) 563-0604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | ME70243 | FL | Yes |

## Other

- **Enumeration date:** 01/14/2014
- **Last updated:** 09/05/2014