Healthcare Provider Details

I. General information

NPI: 1013063908
Provider Name (Legal Business Name): SIDDHARTH PANDYA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 170TH ST
NORTH MIAMI BEACH FL
33169-5521
US

IV. Provider business mailing address

4581 WESTON ROAD BOX 27
WESTON FL
33331-3141
US

V. Phone/Fax

Practice location:
  • Phone: 941-355-9800
  • Fax: 305-651-1100
Mailing address:
  • Phone: 305-654-5221
  • Fax: 305-654-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2003028232
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberOS9113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: