Healthcare Provider Details

I. General information

NPI: 1992623060
Provider Name (Legal Business Name): SHIVKUMAR VIJAYAKUMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15395 NW 82ND AVE
MIAMI LAKES FL
33016-6478
US

IV. Provider business mailing address

15395 NW 82ND AVE
MIAMI LAKES FL
33016-6478
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-1143
  • Fax:
Mailing address:
  • Phone: 305-364-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: