Provider Demographics
NPI:1356833222
Name:GRAYDUS, ROSHNI PANCHAL (APRN)
Entity Type:Individual
Prefix:
First Name:ROSHNI
Middle Name:PANCHAL
Last Name:GRAYDUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11736 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6368
Mailing Address - Country:US
Mailing Address - Phone:352-717-4929
Mailing Address - Fax:
Practice Address - Street 1:235 HATTERAS AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7401
Practice Address - Country:US
Practice Address - Phone:352-717-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV810019363L00000X
FLAPRN11009475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner