Provider Demographics
NPI:1922734425
Name:DAVANAPELLY, PAVITHRA
Entity Type:Individual
Prefix:
First Name:PAVITHRA
Middle Name:
Last Name:DAVANAPELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 STALLION FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3766
Mailing Address - Country:US
Mailing Address - Phone:832-876-1353
Mailing Address - Fax:
Practice Address - Street 1:WALMART HEALTH
Practice Address - Street 2:11108 CAUSEWAY BLVD
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-688-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist