MEDICARE: MEERU DEVAN FENDT P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA3677	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32315	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417925751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEERU DEVAN FENDT P.A.

Provider Business Mailing Address
First Line	:	700 8TH AVE W
Second Line	:	STE 101
City	:	PALMETTO
State	:	FL
Zip	:	34221-4737
Country	:	US
Telephone Number	:	941-776-4008
Fax Number	:	941-845-4963

Provider Business Practice Location Address
First Line	:	1949 NORTHGATE BLVD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-2143
Country	:	US
Telephone Number	:	941-373-7844
Fax Number	:	941-373-7856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2006
Last Update Date	:	03/24/2017

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