Provider Demographics
NPI:1851852081
Name:DEVABHAKTUNI, DIVYA
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:DEVABHAKTUNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 S ORANGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2946
Mailing Address - Country:US
Mailing Address - Phone:321-841-4344
Mailing Address - Fax:321-843-1753
Practice Address - Street 1:1717 S ORANGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:321-841-4344
Practice Address - Fax:321-843-1753
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME176972207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program