Basic Information
Provider Information
NPI: 1366735425
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAVRI
FirstName: SABRINA
MiddleName: NICOLE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1400 S ORANGE AVE
Address2:  
City: ORLANDO
State: FL
PostalCode: 328062134
CountryCode: US
TelephoneNumber: 4076483800
FaxNumber: 3218413305
Practice Location
Address1: 1400 S ORANGE AVE
Address2:  
City: ORLANDO
State: FL
PostalCode: 32806
CountryCode: US
TelephoneNumber: 0764838004
FaxNumber: 4074255203
Other Information
ProviderEnumerationDate: 05/24/2011
LastUpdateDate: 11/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/03/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2086S0122XME135969FLY Allopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery

No ID Information.


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