Healthcare Provider Details

I. General information

NPI: 1891957031
Provider Name (Legal Business Name): PAVANA KUMARI BEERELLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 SUNTREE BLVD STE 5
ROCKLEDGE FL
32955-5789
US

IV. Provider business mailing address

PO BOX 361095
MELBOURNE FL
32936-1095
US

V. Phone/Fax

Practice location:
  • Phone: 321-985-4200
  • Fax: 321-622-4062
Mailing address:
  • Phone: 321-985-4200
  • Fax: 321-622-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME116796
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME116796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: