Provider Demographics
NPI:1932373479
Name:NANAVATI, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:NANAVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MEMORIAL MEDICAL PKWY STE 3816
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5982
Mailing Address - Country:US
Mailing Address - Phone:386-586-1720
Mailing Address - Fax:386-586-5422
Practice Address - Street 1:61 MEMORIAL MEDICAL PKWY STE 3816
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5982
Practice Address - Country:US
Practice Address - Phone:386-586-4765
Practice Address - Fax:386-586-4769
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442447207RI0011X
FLME127733207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028982900001Medicaid
PA343706ZC9XMedicare PIN