Healthcare Provider Details

I. General information

NPI: 1548341563
Provider Name (Legal Business Name): VAISHALI V PHALKE MB BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3011
US

IV. Provider business mailing address

701 W PLYMOUTH AVE
DELAND FL
32720-3236
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0291
  • Fax:
Mailing address:
  • Phone: 386-943-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD27283
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME144777
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME144777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: