Provider Demographics
NPI:1225371644
Name:MISHRA, AVANTIKA (MD)
Entity Type:Individual
Prefix:
First Name:AVANTIKA
Middle Name:
Last Name:MISHRA
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 1:5741 BEE RIDGE RD STE 550
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5080
Mailing Address - Country:US
Mailing Address - Phone:941-361-1100
Mailing Address - Fax:941-361-1103
Practice Address - Street 1:5741 BEE RIDGE RD STE 550
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5080
Practice Address - Country:US
Practice Address - Phone:941-361-1100
Practice Address - Fax:941-361-1103
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME138694207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology