MEDICARE: DR. PRIYA MAHINDRA NAYYAR M.D.

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	207ND0101X	MOHS-Micrographic Surgery Physician	ME127446	FL

General Provider Information

NPI Number	:	1649407719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA MAHINDRA NAYYAR M.D.

Provider Business Mailing Address
First Line	:	3085 DR. MLK JR ST. N
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33704-2034
Country	:	US
Telephone Number	:	727-888-0900
Fax Number	:	727-233-3838

Provider Business Practice Location Address
First Line	:	3085 DR. MLK JR ST. N
Second Line	:
City	:	ST. PETERSBURG
State	:	FL
Zip	:	33704-2034
Country	:	US
Telephone Number	:	727-888-0900
Fax Number	:	727-233-3838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/17/2020

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