=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770574642
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VRINDA S HERSHBERGER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2005
-----------------------------------------------------
Last Update Date | 06/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 E. NEW HAVEN AVENUE
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-834-7776
-----------------------------------------------------
Fax | 407-834-0973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 502 E NEW HAVEN AVE
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32901-5427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-727-2020
-----------------------------------------------------
Fax | 321-726-4061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0107X
-----------------------------------------------------
Taxonomy Name | Retina Specialist (Ophthalmology) Physician
-----------------------------------------------------
License Number | ME90447
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------