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General NPI Number Information
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NPI Number | 1245105162
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Entity Type | Organization
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Legal Business Name | NIIVA CO
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 3741 W. NEPTUNE ST
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City | TAMPA
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State | FL
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Zip | 33629-5118
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Country | US
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Telephone | 813-254-4262
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Fax | 813-251-6415
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Provider Business Mailing Address
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Address Line | 675 S BABCOCK ST
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City | MELBOURNE
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State | FL
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Zip | 32901-1459
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Country | US
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Telephone | 321-951-1010
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Fax | 321-952-4038
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | SHALINI THAREJA
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Credential | MD
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Telephone | 321-951-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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