Basic Information
Provider Information | |||||||||
NPI: | 1215279500 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VAKHARIA | ||||||||
FirstName: | PRIYA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SHARMA | ||||||||
OtherFirstName: | PRIYA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2705 W SAINT ISABEL ST | ||||||||
Address2: |   | ||||||||
City: | TAMPA | ||||||||
State: | FL | ||||||||
PostalCode: | 336076319 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8138795795 | ||||||||
FaxNumber: | 8138774578 | ||||||||
Practice Location | |||||||||
Address1: | 3384 TAMPA RD | ||||||||
Address2: |   | ||||||||
City: | PALM HARBOR | ||||||||
State: | FL | ||||||||
PostalCode: | 346843425 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273339055 | ||||||||
FaxNumber: | 7273339045 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/25/2013 | ||||||||
LastUpdateDate: | 11/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | ME149143 | FL | N |   |   |   |   | 207W00000X | ME149143 | FL | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 017238167 | 05 | DC |   | MEDICAID | 1215279500 | 05 | VA |   | MEDICAID | 111575900 | 05 | FL |   | MEDICAID |