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General NPI Number Information
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NPI Number | 1043210826
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Entity Type | Individual
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Provider Name | PRERNA VIJAYVARGIYA MD
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Gender | Female
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 220 N SYKES CREEK PKWY STE 301
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3490
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Country | US
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Telephone | 321-361-5536
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Fax | 321-361-5543
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME68903
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License Number State | FL
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