Provider Demographics
NPI:1043210826
Name:VIJAYVARGIYA, PRERNA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRERNA
Middle Name:
Last Name:VIJAYVARGIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PRERNA
Other - Middle Name:
Other - Last Name:AGRAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 N SYKES CREEK PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-361-5536
Practice Address - Fax:321-361-5543
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378881400Medicaid
FL378881400Medicaid
F75363Medicare UPIN