Provider Demographics
NPI:1023489309
Name:ACHUTHAN, AJI VALAYIL (ARNP)
Entity type:Individual
Prefix:MRS
First Name:AJI
Middle Name:VALAYIL
Last Name:ACHUTHAN
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:3090 CARUSO CT STE 50
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8510
Mailing Address - Country:US
Mailing Address - Phone:407-481-7179
Mailing Address - Fax:407-481-7190
Practice Address - Street 1:1741 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5745
Practice Address - Country:US
Practice Address - Phone:352-742-3578
Practice Address - Fax:352-742-3581
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9241888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016521900Medicaid