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General NPI Number Information
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NPI Number | 1659738789
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Entity Type | Organization
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Legal Business Name | KAMLESH P PANDYA MD LLC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 8980 S US HIGHWAY 1 SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3482
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Country | US
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Telephone | 772-807-6500
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Fax | 772-807-6501
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Provider Business Mailing Address
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Address Line | 8980 S US HIGHWAY 1 SUITE 101
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3482
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Country | US
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Telephone | 772-807-6500
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Fax | 772-807-6501
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAMLESH P PANDYA
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Credential | MD
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Telephone | 772-807-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | FL ME0059031
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | FL ME0059031
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | FL ME0059031
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License Number State | FL
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