NPIMap

Organization Active NPI

Shree Anitha Prasanna PA

  • Customized Equipment (DME)
  • Titusville, FL
National Provider Identifier
1194199364
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
Legal business name
SHREE ANITHA PRASANNA PA
Doing business as
Space Coast Dentistry
Practice address
1490 Cheney Hwy
Titusville, FL 32780-6250
Phone
(321) 267-3304
Fax
(321) 267-9191
NPI assigned
Nov 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shree Anitha Prasanna
Title
Administrator Officer
Phone
(321) 268-0108

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X
Customized Equipment (DME) 332BC3200X Primary

Addresses

Primary practice location

1490 Cheney Hwy
Titusville, FL 32780-6250

Mailing address

1490 Cheney Hwy
Titusville, FL 32780-6250
Phone (321) 267-3304

Other names 1

  • Space Coast Dentistry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171201001954 FL DME Supplier - Oral Surgery - Dentist 1153688981 Practice locations: Titusville, FL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shree Anitha Prasanna PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1448409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1194199364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 CHENEY HWY",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327806250",
            "telephone_number": "321-267-3304",
            "fax_number": "321-267-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 CHENEY HWY",
            "city": "TITUSVILLE",
            "state": "FL",
            "postal_code": "327806250",
            "telephone_number": "321-267-3304",
            "fax_number": "321-267-9191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREE ANITHA PRASANNA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-25",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "PRASANNA",
        "authorized_official_first_name": "SHREE",
        "authorized_official_middle_name": "ANITHA",
        "authorized_official_title_or_position": "ADMINISTRATOR OFFICER",
        "authorized_official_telephone_number": "321-268-0108"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Space Coast Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Space Coast Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Titusville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.