Provider Demographics
NPI:1164611349
Name:DEVABAVUS, MERCELY RANI (MD)
Entity Type:Individual
Prefix:MS
First Name:MERCELY
Middle Name:RANI
Last Name:DEVABAVUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6117
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-6117
Mailing Address - Country:US
Mailing Address - Phone:352-666-5665
Mailing Address - Fax:352-666-5122
Practice Address - Street 1:10425 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5043
Practice Address - Country:US
Practice Address - Phone:352-666-5665
Practice Address - Fax:352-666-5122
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257212500Medicaid
FL46652Medicare PIN
FLG93816Medicare UPIN
FL46652ZMedicare PIN