Individual
SAN THAWALANTHANNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2290 N RONALD REAGAN BLVD STE 116, LONGWOOD, FL 32750-3534
(407) 215-0095
(407) 261-0523
Mailing address
1000 S LAKE DR, CLEARWATER, FL 33756-4415
(815) 451-2897
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11031100
FL
Other
Enumeration date
02/07/2024
Last updated
11/04/2024
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