Healthcare Provider Details

I. General information

NPI: 1164641783
Provider Name (Legal Business Name): GAURI RAHUL DALVI M.D., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAURI VIJAY GAIKWAD M.D., PH.D

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-7815
  • Fax: 904-259-4675
Mailing address:
  • Phone: 904-259-7815
  • Fax: 904-259-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME129662
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007-01100
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberGETP.LSU.G02010.PD
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: