Provider Demographics
NPI:1790969137
Name:VASUKI, NAGAVARDHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGAVARDHAN
Middle Name:
Last Name:VASUKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-966-7717
Mailing Address - Fax:888-316-2198
Practice Address - Street 1:5401 S CONGRESS AVE STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6636
Practice Address - Country:US
Practice Address - Phone:561-967-5033
Practice Address - Fax:561-967-5424
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL31152207RC0000X
FLME108818207RC0000X
GA001522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine