Provider Demographics
NPI:1437862349
Name:HARRIPERSAUD, KRISHNA PARSUERAM
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:PARSUERAM
Last Name:HARRIPERSAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20800
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4105
Mailing Address - Country:US
Mailing Address - Phone:561-303-0013
Mailing Address - Fax:
Practice Address - Street 1:16215 S JOG RD STE 100
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2387
Practice Address - Country:US
Practice Address - Phone:561-303-0013
Practice Address - Fax:561-499-3199
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119430363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant