Healthcare Provider Details

I. General information

NPI: 1386325314
Provider Name (Legal Business Name): NISHANTHI ARAVINTHAN VIGNESWARAMOORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NISHANTHI VIGNESWARAMOORTHY MD

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

109 NW 133RD TER UNIT 104
DAVIE FL
33325-7686
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4506
  • Fax:
Mailing address:
  • Phone: 225-270-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number182093
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: