MEDICARE: VAIBHAVI DALWADI

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	183500000X	Pharmacist	42846	TN
2	183500000X	Pharmacist	PS58664	FL

General Provider Information

NPI Number	:	1750986394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VAIBHAVI DALWADI

Provider Business Mailing Address
First Line	:	4465 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4465 NORTHLAKE BLVD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6255
Country	:	US
Telephone Number	:	561-622-6803
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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Directions to “ VAIBHAVI DALWADI ” Practice Location

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