Basic Information
| Provider Information | |||||||||
| NPI: | 1629631148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIWARI | ||||||||
| FirstName: | SUSHANT | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4437 COLONY VIEW DR | ||||||||
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| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334637843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616850381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5352 LINTON BLVD | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614984440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2019 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APRN11002822 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.