MEDICARE: NIIVA CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1245105162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIIVA CO

Provider Business Mailing Address
First Line	:	675 S BABCOCK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1459
Country	:	US
Telephone Number	:	321-951-1010
Fax Number	:	321-952-4038

Provider Business Practice Location Address
First Line	:	3741 W. NEPTUNE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5118
Country	:	US
Telephone Number	:	813-254-4262
Fax Number	:	813-251-6415

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	SHALINI THAREJA
Credential	:	MD
Telephone Number	:	321-951-1010

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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Directions to “NIIVA CO ” Practice Location

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