Healthcare Provider Details

I. General information

NPI: 1639630312
Provider Name (Legal Business Name): UDAY MATHUR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W ATLANTIC AVE #300
DELRAY BEACH FL
33484
US

IV. Provider business mailing address

5341 W ATLANTIC AVE 300
DELRAY BEACH FL
33484
US

V. Phone/Fax

Practice location:
  • Phone: 561-858-8767
  • Fax: 561-516-8769
Mailing address:
  • Phone: 561-858-8767
  • Fax: 561-516-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME162927
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME162927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: