Individual
MIRANDA KAVITA PERSAUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
PO BOX 1268, NEW SMYRNA BEACH, FL 32170-1268
(386) 259-8803
(386) 213-9981
Mailing address
6710 COLLINS RD APT 2509, JACKSONVILLE, FL 32244-5888
(754) 422-6886
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
PA9115776
FL
363A00000X
Physician Assistant
PA9115776
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202248493
—
FL
Enumeration date
07/14/2022
Last updated
07/12/2024
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