Provider Demographics
NPI:1023233087
Name:PANDYA, NEHA MEHUL (DMD)
Entity type:Individual
Prefix:MRS
First Name:NEHA
Middle Name:MEHUL
Last Name:PANDYA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:NEHA
Other - Middle Name:KRISHNAKANT
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:945 PELICAN BAY DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8329
Mailing Address - Country:US
Mailing Address - Phone:267-616-1365
Mailing Address - Fax:
Practice Address - Street 1:15 SAINT JOHNS MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-797-9044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023016001223E0200X
PADS031484L1223E0200X
PADS031484-L1223E0200X
FLDN232301223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics