Provider Demographics
NPI:1326288721
Name:KISHOR, SOWMYA IYER (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOWMYA
Middle Name:IYER
Last Name:KISHOR
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 1:143 VIERA DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1741
Mailing Address - Country:US
Mailing Address - Phone:757-218-1597
Mailing Address - Fax:
Practice Address - Street 1:4475 MEDICAL CENTER WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3240
Practice Address - Country:US
Practice Address - Phone:561-863-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102622207N00000X
FLME 102622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology