Provider Demographics
NPI:1073197141
Name:DIPURAJ, BINDHU
Entity Type:Individual
Prefix:
First Name:BINDHU
Middle Name:
Last Name:DIPURAJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BINDHU
Other - Middle Name:
Other - Last Name:PURUSHOTHAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5212 NW 98TH LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5212 NW 98TH LN
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2490
Practice Address - Country:US
Practice Address - Phone:954-742-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily