Healthcare Provider Details

I. General information

NPI: 1114803251
Provider Name (Legal Business Name): PAVAN MAKAVANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17358 SW 36TH ST
MIRAMAR FL
33029-1606
US

IV. Provider business mailing address

17358 SW 36TH ST
MIRAMAR FL
33029-1606
US

V. Phone/Fax

Practice location:
  • Phone: 954-743-8970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number13465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: