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General NPI Number Information
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NPI Number | 1154940690
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Entity Type | Individual
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Provider Name | DIVYA JOSEPH AICKARA MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 11601 SHELDON RD
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City | TAMPA
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State | FL
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Zip | 33626-4306
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Country | US
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Telephone | 813-324-6630
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Fax | 813-926-1500
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Provider Business Mailing Address
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Address Line | 4197 WOODLANDS PKWY
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City | PALM HARBOR
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State | FL
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Zip | 34685-3493
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Country | US
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Telephone | 813-333-1512
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Fax | 813-333-1561
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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 | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME169912
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License Number State | FL
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