Provider Demographics
NPI:1700136678
Name:MAHESHWARI, PREM (PHD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:
Last Name:MAHESHWARI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15075 SW 19TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4326
Mailing Address - Country:US
Mailing Address - Phone:954-704-1949
Mailing Address - Fax:954-730-2337
Practice Address - Street 1:15075 SW 19TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4326
Practice Address - Country:US
Practice Address - Phone:954-704-1949
Practice Address - Fax:954-730-2337
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRP-95174H00000X, 2471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation TherapyGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty