Healthcare Provider Details

I. General information

NPI: 1669665881
Provider Name (Legal Business Name): NINA ABHAY BHATT M.B.; B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINABAHEN DEVENDRAPRASAD DAVE

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE
NORFOLK VA
23510-1065
US

IV. Provider business mailing address

PO BOX 843035
BOSTON MA
02284-3035
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number568-L
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101282327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: