Doctor Name: | DIVYA PANNEERSELVAM |
NPI Number: | 1083026108 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 305 Sw 2nd Ter Cape Coral, FL - 339911958 |
Business Phone Number: | 2393442320 |
Business Fax Number: | 2395733226 |
Mailing Address: | Po Box 1357, FORT MYERS |
State: | FL |
Postal Code: | 339021357 |
Phone Number: | 2392783600 |
Fax Number: | 2392783857 |
NPI Enumeration Date: | 05/22/2014 |
NPI Last Update Date: | 06/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |