Healthcare Provider Details

I. General information

NPI: 1154940690
Provider Name (Legal Business Name): DIVYA JOSEPH AICKARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 SHELDON RD
TAMPA FL
33626-4306
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 813-324-6630
  • Fax: 813-926-1500
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME169912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: