Individual
CHANDRA SHEKAR BABU ANAVALAMUDI THYAGARAJ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8386 N MISSIONWOOD CIR, MIRAMAR, FL 33025-2935
(954) 683-3617
Mailing address
8386 N MISSIONWOOD CIR, MIRAMAR, FL 33025-2935
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
11019662
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36176139
—
FL
Enumeration date
01/25/2023
Last updated
01/25/2023
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