Healthcare Provider Details

I. General information

NPI: 1366158644
Provider Name (Legal Business Name): RAVI VIRADIA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 09/02/2025
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24426 SR 54
LUTZ FL
33559-7303
US

IV. Provider business mailing address

24426 SR 54
LUTZ FL
33559-7303
US

V. Phone/Fax

Practice location:
  • Phone: 813-708-1408
  • Fax: 888-383-2979
Mailing address:
  • Phone: 813-708-1408
  • Fax: 888-383-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARUSHI SHARMA
Title or Position: OFFICE MANAGER
Credential: MBA
Phone: 813-708-1408