Provider Demographics
NPI:1588658819
Name:KIRI, NANDINI (MD PA)
Entity Type:Individual
Prefix:DR
First Name:NANDINI
Middle Name:
Last Name:KIRI
Suffix:
Gender:F
Credentials:MD PA
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 495237
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5237
Mailing Address - Country:US
Mailing Address - Phone:941-889-7440
Mailing Address - Fax:941-391-6089
Practice Address - Street 1:21202 OLEAN BLVD STE C1
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6725
Practice Address - Country:US
Practice Address - Phone:941-889-7440
Practice Address - Fax:941-391-6089
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261577100Medicaid
FL05106OtherBCBS
FLE5910YMedicare PIN
FLP00058990Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLH43933Medicare UPIN
FLE5910Medicare ID - Type Unspecified