Provider Demographics
NPI:1780986448
Name:MATHUR, NIVEDITA (MD)
Entity type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:
Last Name:MATHUR
Suffix:
Gender:F
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:PO BOX 3399
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-3399
Mailing Address - Country:US
Mailing Address - Phone:352-293-3467
Mailing Address - Fax:352-293-4438
Practice Address - Street 1:11373 CORTEZ BLVD STE 301
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5411
Practice Address - Country:US
Practice Address - Phone:352-293-3467
Practice Address - Fax:352-293-4438
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1957872084P0800X
FLME1215372084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014665700Medicaid
FLIB270ZMedicare PIN