Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | ME113647 | FL |
Y | 208000000X | Pediatrician | ME113647 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | ME113647 | FL |
NPI | 1295997666 |
---|---|
Provider Name | Dr. Bernadette C. Antonyrajah |
First Address | Orlando, FL 32835-8515 |
Second Address | Orlando, FL 32835-8515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 22/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006240200 | (05) | FL |