Healthcare Provider Details

I. General information

NPI: 1710985593
Provider Name (Legal Business Name): NIKHITA DHRUV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W EAU GALLIE BLVD SUITE 100
MELBOURNE FL
32935-3133
US

IV. Provider business mailing address

2290 W EAU GALLIE BLVD SUITE 100
MELBOURNE FL
32935-3133
US

V. Phone/Fax

Practice location:
  • Phone: 321-309-9000
  • Fax: 321-309-9002
Mailing address:
  • Phone: 321-309-9000
  • Fax: 321-309-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME73417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: