Healthcare Provider Details

I. General information

NPI: 1720668858
Provider Name (Legal Business Name): HASAN FAIYAAZ JHAVERI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 NEWELL DR
GAINESVILLE FL
32610-3011
US

IV. Provider business mailing address

9134 GREAT HERON CIR
ORLANDO FL
32836-5487
US

V. Phone/Fax

Practice location:
  • Phone: 863-206-8183
  • Fax:
Mailing address:
  • Phone: 407-876-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: