Healthcare Provider Details

I. General information

NPI: 1427219724
Provider Name (Legal Business Name): NIVEDITA UBEROI JERATH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N PARK AVE STE 301
APOPKA FL
32703
US

IV. Provider business mailing address

201 N PARK AVE STE 301
APOPKA FL
32703-4147
US

V. Phone/Fax

Practice location:
  • Phone: 407-614-0528
  • Fax: 407-614-0529
Mailing address:
  • Phone: 407-614-0528
  • Fax: 407-614-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME131635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: