Healthcare Provider Details

I. General information

NPI: 1942443619
Provider Name (Legal Business Name): NYLA HAZRATJEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 LAKELAND HIGHLANDS RD
LAKELAND FL
33812-4507
US

IV. Provider business mailing address

4000 LAKELAND HIGHLANDS RD
LAKELAND FL
33812-4507
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3900
  • Fax: 321-843-6075
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.098814
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number40015
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME128835
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberT3300
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME128835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: