Provider Demographics
NPI:1154362333
Name:RAJA, JAVALIKA GADHIA (PA)
Entity type:Individual
Prefix:
First Name:JAVALIKA
Middle Name:GADHIA
Last Name:RAJA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAVALIKA
Other - Middle Name:
Other - Last Name:RAJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9699
Mailing Address - Fax:
Practice Address - Street 1:1414 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:407-405-0707
Practice Address - Fax:407-654-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102156363A00000X
FLPA 9102156207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ42595Medicare UPIN
FLU5357XMedicare ID - Type Unspecified