Provider Demographics
NPI:1548532559
Name:KALLICHARAN, SATIE (PA-C)
Entity type:Individual
Prefix:
First Name:SATIE
Middle Name:
Last Name:KALLICHARAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE E-214
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-318-6590
Mailing Address - Fax:954-318-6604
Practice Address - Street 1:7401 N. UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2933
Practice Address - Country:US
Practice Address - Phone:954-722-0130
Practice Address - Fax:954-722-0132
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant