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General NPI Number Information
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NPI Number | 1639241862
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Entity Type | Individual
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Provider Name | GEETHA PRIYANKA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 948 S WICKHAM RD SUITE 103
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1647
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Country | US
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Telephone | 321-956-7370
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Fax | 321-956-7873
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Provider Business Mailing Address
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Address Line | 948 S WICKHAM RD SUITE 103
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-1647
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Country | US
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Telephone | 321-956-7370
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Fax | 321-956-7873
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78873
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License Number State | FL
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