=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790691434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S CARDIOLOGY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2026
-----------------------------------------------------
Last Update Date | 08/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6735 CONROY RD STE 414
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-588-0550
-----------------------------------------------------
Fax | 888-494-2369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6735 CONROY RD STE 414
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-588-0550
-----------------------------------------------------
Fax | 888-494-2369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. BHAVYA TRIVEDI
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 407-588-0550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------