Healthcare Provider Details

I. General information

NPI: 1316401508
Provider Name (Legal Business Name): PUSHPA NJARAVELIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 N STERLING RANCH CIR
DAVIE FL
33314-7258
US

IV. Provider business mailing address

5354 N STERLING RANCH CIR
DAVIE FL
33314-7258
US

V. Phone/Fax

Practice location:
  • Phone: 954-224-1878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN11000676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: