MEDICARE: PUSHPA DALIYA APRN

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	208100000X	Physical Medicine & Rehabilitation Physician	9331110	FL
2	363L00000X	Nurse Practitioner	APRN9331110	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NZ109	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841761673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUSHPA DALIYA APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-327-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	7332 OFFICE PARK PL STE 103
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8241
Country	:	US
Telephone Number	:	321-327-9788
Fax Number	:

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

Provider Enumeration Date	:	12/05/2018
Last Update Date	:	09/21/2021

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Directions to “ PUSHPA DALIYA APRN” Practice Location

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