Provider Demographics
NPI:1679185300
Name:DWIVEDI, SHREYAN (RPH)
Entity Type:Individual
Prefix:DR
First Name:SHREYAN
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 CUMIN DR
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-5444
Mailing Address - Country:US
Mailing Address - Phone:954-226-0486
Mailing Address - Fax:
Practice Address - Street 1:395 CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3326
Practice Address - Country:US
Practice Address - Phone:407-343-8224
Practice Address - Fax:407-343-8339
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS60108OtherDEPARTMENT OF HEALTH AND QUALITY ASSURANCE