Healthcare Provider Details

I. General information

NPI: 1467814475
Provider Name (Legal Business Name): LAVINA DAYANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVINA JETHANI

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE SE
PUYALLUP WA
98372-3715
US

IV. Provider business mailing address

39 COUNTRY VIEW DR
FREEHOLD NJ
07728-9019
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-3265
  • Fax: 931-208-3645
Mailing address:
  • Phone: 732-625-0072
  • Fax: 931-208-3645

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBP10069716
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberMD61281055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: