Provider Demographics
NPI:1750560983
Name:PRIYAMVADA, TATACHAR (MD)
Entity type:Individual
Prefix:DR
First Name:TATACHAR
Middle Name:
Last Name:PRIYAMVADA
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 1:3100 SW 62ND AVE
Mailing Address - Street 2:NICKLAUS CHILDREN'S HOSPITAL
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:786-624-2891
Mailing Address - Fax:305-669-6531
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:NICKLAUS CHILDREN'S HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:786-624-2891
Practice Address - Fax:305-669-6531
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002927208000000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909020Medicaid