Healthcare Provider Details

I. General information

NPI: 1245894211
Provider Name (Legal Business Name): NIKITA CHADHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOS 12902 MAGNOLIA DRIVE
TAMPA FL
33612
US

IV. Provider business mailing address

MOFFITT CANCER CENTER 12902 MAGNOLIA DRIVE
TAMPA FL
33612
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4989
  • Fax:
Mailing address:
  • Phone: 813-745-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102207266
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberUO11282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: