Provider Demographics
NPI:1952493264
Name:DHADUVAI, VIJAYALAKSHMI (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYALAKSHMI
Middle Name:
Last Name:DHADUVAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2007
Mailing Address - Country:US
Mailing Address - Phone:941-729-6818
Mailing Address - Fax:941-723-9449
Practice Address - Street 1:2901 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2007
Practice Address - Country:US
Practice Address - Phone:941-729-6818
Practice Address - Fax:941-723-9449
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23522Medicare ID - Type Unspecified
FLF68699Medicare UPIN