Provider Demographics
NPI:1245105162
Name:NIIVA CO
Entity type:Organization
Organization Name:NIIVA CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHALINI
Authorized Official - Middle Name:
Authorized Official - Last Name:THAREJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-951-1010
Mailing Address - Street 1:675 S BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1459
Mailing Address - Country:US
Mailing Address - Phone:321-951-1010
Mailing Address - Fax:321-952-4038
Practice Address - Street 1:3741 W. NEPTUNE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5118
Practice Address - Country:US
Practice Address - Phone:813-254-4262
Practice Address - Fax:813-251-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty