Provider Demographics
NPI:1528422318
Name:MOHANACHANDRAN PILLAI GEETHA DEVI, GAYATHRI
Entity type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:
Last Name:MOHANACHANDRAN PILLAI GEETHA DEVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 DREW ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:772-315-6974
Mailing Address - Fax:
Practice Address - Street 1:28864 WESLEY CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3228
Practice Address - Country:US
Practice Address - Phone:813-998-2870
Practice Address - Fax:813-998-2871
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139279207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine