Healthcare Provider Details

I. General information

NPI: 1437659836
Provider Name (Legal Business Name): ALLA MEZHEVAYA RDMS, RVT, RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GRAHAM ST SW
PORT CHARLOTTE FL
33952-9122
US

IV. Provider business mailing address

109 GRAHAM ST SW
PORT CHARLOTTE FL
33952-9122
US

V. Phone/Fax

Practice location:
  • Phone: 410-522-8831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: