Provider Demographics
NPI:1639124746
Name:GHAYAL, VARSHA (MD)
Entity Type:Individual
Prefix:
First Name:VARSHA
Middle Name:
Last Name:GHAYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VARSHA
Other - Middle Name:
Other - Last Name:NATHWANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2300 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3825
Practice Address - Country:US
Practice Address - Phone:863-647-8012
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95643208000000X
NJ25MA07349500208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56330OtherFL BLUE
FL0471260003Medicare NSC
I29550Medicare UPIN
NJ0065935Medicaid