Healthcare Provider Details

I. General information

NPI: 1194427948
Provider Name (Legal Business Name): JERATIVAT SATAYAREKHA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

8770 MAITLAND SUMMIT BLVD UNIT 2212
ORLANDO FL
32810-6005
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5500
  • Fax:
Mailing address:
  • Phone: 407-729-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS22884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: