Provider Demographics
NPI:1730851635
Name:KASETTY, HARISH (PA-C)
Entity type:Individual
Prefix:
First Name:HARISH
Middle Name:
Last Name:KASETTY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1801 LEE RD STE 115-175
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2162
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:407-647-5496
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2025-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9114914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730851635Medicaid