Healthcare Provider Details

I. General information

NPI: 1033867692
Provider Name (Legal Business Name): MRS. PRITI MAHESHWARI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EAST SAMPLE ROAD
DEERFIELD BEACH FL
33064
US

IV. Provider business mailing address

601 E SAMPLE RD STE 101
DEERFIELD BEACH FL
33064-4443
US

V. Phone/Fax

Practice location:
  • Phone: 954-942-9233
  • Fax:
Mailing address:
  • Phone: 954-461-7941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10614
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: