Healthcare Provider Details

I. General information

NPI: 1699470062
Provider Name (Legal Business Name): NIKITA AGARWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5540 E GRANT ST STE A
ORLANDO FL
32822-1668
US

IV. Provider business mailing address

5540 E GRANT ST STE A
ORLANDO FL
32822-1668
US

V. Phone/Fax

Practice location:
  • Phone: 407-367-4706
  • Fax: 321-203-4606
Mailing address:
  • Phone: 407-367-4706
  • Fax: 321-203-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME182202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: