Individual
ANITHA JAGADISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2115 SE LENNARD RD, PORT SAINT LUCIE, FL 34952-4742
(772) 335-1812
(772) 335-1825
Mailing address
2115 SE LENNARD RD, PORT SAINT LUCIE, FL 34952-4742
(772) 335-1812
(772) 335-1825
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME 80942
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260740900
—
FL
Enumeration date
12/07/2006
Last updated
12/09/2019
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