Provider Demographics
NPI:1932175502
Name:PANDYA & NIME MD PA
Entity Type:Organization
Organization Name:PANDYA & NIME MD PA
Other - Org Name:PATHOLOGY AND MEDICAL LABORATORY DIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHONDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-636-2211
Mailing Address - Street 1:PO BOX 1943
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1943
Mailing Address - Country:US
Mailing Address - Phone:877-261-9061
Mailing Address - Fax:
Practice Address - Street 1:110 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2828
Practice Address - Country:US
Practice Address - Phone:321-636-2211
Practice Address - Fax:321-633-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055386700Medicaid
FL055386703Medicaid