Healthcare Provider Details

I. General information

NPI: 1720454259
Provider Name (Legal Business Name): MEERA GHAYAL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W DR MARTIN LUTHER KING JR BLVD
SEFFNER FL
33584-4534
US

IV. Provider business mailing address

10051 5TH ST N STE 200
ST PETERSBURG FL
33702-2211
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-7005
  • Fax: 813-654-1050
Mailing address:
  • Phone: 727-824-0780
  • Fax: 727-568-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO4462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: