Provider Demographics
NPI:1770574642
Name:HERSHBERGER, VRINDA S (MD)
Entity type:Individual
Prefix:
First Name:VRINDA
Middle Name:S
Last Name:HERSHBERGER
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 1:502 E NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5427
Mailing Address - Country:US
Mailing Address - Phone:321-727-2020
Mailing Address - Fax:321-726-4061
Practice Address - Street 1:502 E. NEW HAVEN AVENUE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:407-834-7776
Practice Address - Fax:407-834-0973
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90447207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269906100Medicaid
FLBH8360620OtherDEA#
FL48330UMedicare PIN
FL48330XMedicare PIN
FL269906100Medicaid
FL48330YMedicare PIN
FLH91374Medicare UPIN