Provider Demographics
NPI:1336365907
Name:NIRMALA INC
Entity Type:Organization
Organization Name:NIRMALA INC
Other - Org Name:SUNSHINE PEDIATRICS OF LUTZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-758-1749
Mailing Address - Street 1:18928 N. DALE MABRY HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548
Mailing Address - Country:US
Mailing Address - Phone:813-948-2679
Mailing Address - Fax:813-948-2694
Practice Address - Street 1:18928 N. DALE MABRY HWY
Practice Address - Street 2:STE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548
Practice Address - Country:US
Practice Address - Phone:813-948-2679
Practice Address - Fax:813-948-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90168208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271493100Medicaid
FL$$$$$$$$$OtherSOCIAL SECURITY
FL=========OtherEIN NIRMALA INC