Provider Demographics
NPI:1699264994
Name:VIJAYARAGHAVAN, NEVIN (DO)
Entity type:Individual
Prefix:
First Name:NEVIN
Middle Name:
Last Name:VIJAYARAGHAVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 HANSON RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-3110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D SPORTS MEDICINE & ORTHOPAEDIC CENTER
Practice Address - Street 2:141 COCONUT DRIVE
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903
Practice Address - Country:US
Practice Address - Phone:321-989-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01662208100000X
NC238332390200000X
FLOS206452081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program