Healthcare Provider Details

I. General information

NPI: 1912668963
Provider Name (Legal Business Name): HEARTWELL MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 N ORLANDO AVE STE 205
WINTER PARK FL
32789-2213
US

IV. Provider business mailing address

1035 N ORLANDO AVE STE 205
WINTER PARK FL
32789-2213
US

V. Phone/Fax

Practice location:
  • Phone: 321-274-8701
  • Fax: 321-274-8702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAGHAV SHARMA
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 513-965-1391