Healthcare Provider Details

I. General information

NPI: 1366861189
Provider Name (Legal Business Name): PIYUSH VINAYAK SOVANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 N HABANA AVE FL 2
TAMPA FL
33614-7101
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-875-9000
  • Fax: 813-874-3278
Mailing address:
  • Phone: 727-532-1355
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME143890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: