Provider Demographics
NPI:1710070818
Name:MENON, MEERA NIRMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEERA
Middle Name:NIRMAL
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEERA
Other - Middle Name:AYYANOOR
Other - Last Name:VEETEKKAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:STE 206E
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-684-8045
Mailing Address - Fax:813-684-8046
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:SUITE 206E
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-684-8045
Practice Address - Fax:813-684-8046
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95712208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280048900Medicaid