Provider Demographics
NPI:1619081023
Name:GANDHI, PRACHI (DO)
Entity Type:Individual
Prefix:DR
First Name:PRACHI
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PRACHI
Other - Middle Name:C
Other - Last Name:DOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1027 TOWN CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8360
Mailing Address - Country:US
Mailing Address - Phone:386-218-0222
Mailing Address - Fax:386-218-0201
Practice Address - Street 1:1027 TOWN CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8360
Practice Address - Country:US
Practice Address - Phone:386-218-0222
Practice Address - Fax:386-218-0201
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS 10323OtherFLORIDA MEDICAL LICENSE
IL036116471OtherLICENSE NUMBER
FL004639800Medicaid