Healthcare Provider Details

I. General information

NPI: 1902091218
Provider Name (Legal Business Name): RESHMA L MAHTANI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 S PINE ISLAND RD STE 410
PLANTATION FL
33324-4583
US

IV. Provider business mailing address

PO BOX 743144
ATLANTA GA
30374-3144
US

V. Phone/Fax

Practice location:
  • Phone: 954-837-1490
  • Fax: 954-837-1188
Mailing address:
  • Phone: 954-837-1490
  • Fax: 954-837-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS10191
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberOS10191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: