| Brevard Internal Medicine & Walk-in Clinic | |
|
2795 W New Haven Ave W Melbourne FL 32904-3705 | |
| (321) 622-8626 | |
| (321) 622-8627 |
| Full Name | Brevard Internal Medicine & Walk-in Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2795 W New Haven Ave, W Melbourne, Florida |
| Authorized Official Name and Position | Aravind Kumar (SOLE OWNER) |
| Authorized Official Contact | 3216228626 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brevard Internal Medicine & Walk-in Clinic Po Box 411685 Melbourne FL 32941-1685 Ph: (321) 622-8626 | Brevard Internal Medicine & Walk-in Clinic 2795 W New Haven Ave W Melbourne FL 32904-3705 Ph: (321) 622-8626 |
| NPI Number | 1710216262 |
|---|---|
| Provider Enumeration Date | 12/11/2009 |
| Last Update Date | 02/07/2014 |
| Medicare PECOS PAC ID | 9133254980 |
|---|---|
| Medicare Enrollment ID | O20100318000081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710216262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME97764 (Florida) | Primary |
| 261QP2300X | Clinic/center - Primary Care | ARNP 2107012 (Florida) | Secondary |
| Provider Name | Rajasri Priyadarshini Krishnamurthy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457408932 PECOS PAC ID: 2961504428 Enrollment ID: I20070301000415 |
| Provider Name | Aravind K Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871539072 PECOS PAC ID: 6507844560 Enrollment ID: I20070823000377 |
| Provider Name | Jacqueline A Felder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134272453 PECOS PAC ID: 6800954215 Enrollment ID: I20081028000740 |
| Provider Name | Ada Maria Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518210970 PECOS PAC ID: 3274784228 Enrollment ID: I20121121000408 |
| Provider Name | Amanda Nolte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548645856 PECOS PAC ID: 3375858418 Enrollment ID: I20150818005311 |
| Provider Name | Dannielle Lorain O'hare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750890471 PECOS PAC ID: 5193086981 Enrollment ID: I20180217000076 |
Steven J Vanderby Md P.a. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4030 Minton Rd, W Melbourne, FL 32904 Phone: 321-725-8222 Fax: 321-676-2299 |