Provider Demographics
NPI:1457509168
Name:IYENGAR, REVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:REVATHI
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REVATHI
Other - Middle Name:R
Other - Last Name:SATHYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 100236
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0236
Mailing Address - Country:US
Mailing Address - Phone:352-273-5550
Mailing Address - Fax:352-273-5575
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-5467
Practice Address - Fax:352-315-3633
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1138062084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology