Healthcare Provider Details

I. General information

NPI: 1407102999
Provider Name (Legal Business Name): DR. SARIKA B HEGGANNAVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E MERRITT ISLAND CSWY
MERRITT ISLAND FL
32952-3514
US

IV. Provider business mailing address

10412 PLAZA CENTRO
BOCA RATON FL
33498-6723
US

V. Phone/Fax

Practice location:
  • Phone: 321-453-8882
  • Fax:
Mailing address:
  • Phone: 561-237-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: