Provider Demographics
NPI:1861788390
Name:GOSALIA, NIKITA P (DO)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:P
Last Name:GOSALIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:P
Other - Last Name:PATRAWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:2777 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8310
Practice Address - Country:US
Practice Address - Phone:386-774-2550
Practice Address - Fax:386-774-1691
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA249314207R00000X
FLOS12579207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014057500Medicaid