Healthcare Provider Details

I. General information

NPI: 1669475646
Provider Name (Legal Business Name): NARESH V MODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N WASHINGTON AVE STE 100
TITUSVILLE FL
32796-2152
US

IV. Provider business mailing address

605 N WASHINGTON AVE STE 100
TITUSVILLE FL
32796-2152
US

V. Phone/Fax

Practice location:
  • Phone: 321-383-7600
  • Fax: 321-383-8111
Mailing address:
  • Phone: 321-383-7600
  • Fax: 321-383-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number62797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: