Provider Demographics
NPI:1407454069
Name:MULDEO, GAYATRI (MSN, APRN, FNC-C)
Entity Type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:MULDEO
Suffix:
Gender:F
Credentials:MSN, APRN, FNC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15035 MICHELANGELO BLVD APT 303
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2898
Mailing Address - Country:US
Mailing Address - Phone:352-426-1066
Mailing Address - Fax:
Practice Address - Street 1:15035 MICHELANGELO BLVD APT 303
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2898
Practice Address - Country:US
Practice Address - Phone:352-426-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner