Healthcare Provider Details

I. General information

NPI: 1124451794
Provider Name (Legal Business Name): DIVYA KARJALA CHAKKARAVARTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 COLUMBIA ST
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

62 COLUMBIA ST
ORLANDO FL
32806-1115
US

V. Phone/Fax

Practice location:
  • Phone: 407-514-3668
  • Fax: 321-843-2196
Mailing address:
  • Phone: 407-514-3668
  • Fax: 321-843-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125063539
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME180725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: