Provider Demographics
NPI:1255986113
Name:DIVANI DERMATOLOGY LLC
Entity type:Organization
Organization Name:DIVANI DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:HARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-217-5362
Mailing Address - Street 1:8745 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-7524
Mailing Address - Country:US
Mailing Address - Phone:772-217-5362
Mailing Address - Fax:772-218-7267
Practice Address - Street 1:8745 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-7524
Practice Address - Country:US
Practice Address - Phone:772-217-5362
Practice Address - Fax:772-218-7267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty