Provider Demographics
NPI:1497134498
Name:HARYANI, DIVYA SADHWANI (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:SADHWANI
Last Name:HARYANI
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:PO BOX 700305
Mailing Address - Street 2:
Mailing Address - City:WABASSO
Mailing Address - State:FL
Mailing Address - Zip Code:32970-0305
Mailing Address - Country:US
Mailing Address - Phone:772-217-5362
Mailing Address - Fax:
Practice Address - Street 1:8745 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-7524
Practice Address - Country:US
Practice Address - Phone:772-217-5362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135907207N00000X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program