Provider Demographics
NPI:1982613550
Name:RAVINDRAN, VIJAYA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:L
Last Name:RAVINDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15160 HARBOUR ISLE DR APT 701
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6846
Mailing Address - Country:US
Mailing Address - Phone:239-939-3939
Mailing Address - Fax:239-931-6107
Practice Address - Street 1:3033 WINKLER AVENUE EXT
Practice Address - Street 2:VA OPC
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9413
Practice Address - Country:US
Practice Address - Phone:239-939-3939
Practice Address - Fax:239-931-6107
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232112084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry