DR. KALYANI MANJUL DERASARI (NPI# 1689835357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689835357 |
| Entity Type | Individual |
| Full Name | DR. KALYANI MANJUL DERASARI |
| Other Name | DR. KALYANI MANJUL DERASARI |
| Credential | M.D. |
| Practice Address |
4202 E Fowler Ave Shs-100 Tampa FL 33620-9951 |
| Mailing Address |
Po Box 917770 Orlando FL 32891-0001 |
| Practice Telephone | 8139742331 |
| Practice Fax Number | 8139747181 |
| Mailing Telephone | 8139742201 |
| Mailing Fax Number | 8139742812 |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-10-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
ME52057 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 000199700 | 05 | |
| FL | BLUE CROSS BLUE SHIELD | 05667 | 01 |
| Street Address |
4202 E FOWLER AVE SHS-100 |
| City | TAMPA |
| State | FL |
| Zip Code | 33620-9951 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992793004 | Melissa M Bailey | Nurse Practitioner | 4202 E Fowler Ave, Shs100, Tampa, FL 33620-6750 | 2005-10-12 |
| 1023615226 | Allison Bootz | Student in an Organized Health Care Education/Training Program | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2020-10-01 |
| 1265050926 | Macy Franklin | Specialist/Technologist | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2020-07-09 |
| 1043834351 | Marian Alice Lowther | Speech-Language Pathologist | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2020-06-02 |
| 1235750928 | Bethany Moorhouse | Student in an Organized Health Care Education/Training Program | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2020-05-04 |
| 1245872985 | Stacey Julia Struhar | Dietitian, Registered | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2019-10-15 |
| 1609439074 | Khalid Shakfeh | Student in an Organized Health Care Education/Training Program | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2019-04-20 |
| 1598228256 | Isabella Abbasi | Specialist/Technologist | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2019-04-10 |
| 1396201448 | Vanessa Chantal Barber | Social Worker | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2019-02-13 |
| 1588128698 | Kassandra Lynch | Specialist/Technologist | 4202 E Fowler Ave, Tampa, FL 33620-8000 | 2019-01-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689145542 | Ramon Ramirez | Specialist/Technologist | 4202 E Fowler Ave., Ath 100, Tampa, FL 33620 | 2018-12-17 |
| 1093818908 | Theresa Hnath-chisolm | Audiologist | 4202 E Fowler Aveune, University of South Florida PCd 1017, Tampa, FL 33620 | 2006-09-06 |
| 1215303805 | Kaitlyn Rechenberg | Nurse Practitioner | 4202 E Fowler Ave Stop Shs100, Tampa, FL 33620 | 2015-08-18 |
| 1245527738 | Kelli Gorajec | Speech-Language Pathologist | 4202 E Fowler Ave Stop PCd1017, Tampa, FL 33620 | 2011-07-05 |
| 1487843637 | Jane Bradley Smart | Speech-Language Pathologist | 4202 E Fowler Ave Stop PCd1017, Tampa, FL 33620 | 2007-10-23 |
| 1912082199 | Rebecca Marie Lutz | Nurse Practitioner | 4202 E Fowler Ave Stop Shs100, Tampa, FL 33620 | 2006-10-26 |
| 1306956206 | Wendy Weiss | Family Medicine | 4202 E Fowler Ave Stop Shs100, Tampa, FL 33620 | 2006-08-30 |
| 1518472901 | Kacey Garcia Poulin | Speech-Language Pathologist | 4202 E Fowler Ave PCd2000, Tampa, FL 33620-0001 | 2017-12-06 |
| 1598275695 | Laura Anne Marshall | Behavior Technician | Usf Birch Drive, Tampa, FL 33620-0001 | 2017-10-04 |
| 1053793026 | University Medical Service Association Inc | Clinical Medical Laboratory | 4107 Usf Cedar Cir, Ste 171, Tampa, FL 33620-0001 | 2015-06-25 |
| Find all providers in zip 33620 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720494024 | Focus-fl 1012 Pllc | Pediatrics | 1501 S Dale Mabry Hwy Ste A6, Tampa, FL 33629-5837 | 2014-07-08 |
| 1154505832 | Clarence A Renschler | Pediatrics | 98 Baltic Cir, Tampa, FL 33606-3320 | 2007-12-18 |
| 1780846691 | Earl Arthur Smith | Pediatrics | 5124 N Armenia Ave, Tampa, FL 33603-1406 | 2008-07-01 |
| 1760559306 | James P Orlowski | Pediatrics | 3100 E Fletcher Ave, Tampa, FL 33613-4613 | 2006-11-29 |
| 1538185616 | Tabassum Shamim | Pediatrics | 3709 W Hamilton Ave, Suite # 4, Tampa, FL 33614-4015 | 2006-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1609424217 | North Florida Pediatrics, Pa | Pediatrics | 145 Hilden Road Suite 101, Ponte Vedra, FL 32081 | 2019-08-27 |
| 1841794682 | W.b. Stewart Tigers Athletics Boosters | Pediatrics | 1658 Kings Rd, Jacksonville, FL 32209-6167 | 2018-03-19 |
| 1710330923 | Juan Ruiz-unger Md Pa | Pediatrics | 8900 Sw 24th St Ste 204, Miami, FL 33165-2075 | 2016-07-22 |
| 1922479625 | Bee Well Kidz Inc | Pediatrics | 13802 Landstar Blvd Ste 109, Orlando, FL 32824-5500 | 2015-10-08 |
| 1326418336 | Abc Pediatrics of Okaloosa | Pediatrics | 182 E. Redstone Ave, Suite B, Crestview, FL 32539 | 2015-10-02 |
| 1679965487 | Howard I Finer Md Faap | Pediatrics | 2135 W State Road 434, Longwood, FL 32779-4983 | 2015-03-03 |
| 1154712198 | Pediatric &adolescent Medicine | Pediatrics | 7150 W 20th Ave Ste 612, Hialeah, FL 33016-5534 | 2015-02-12 |
| 1689064750 | Hilda Tejero | Pediatrics | 9495 Sunset Dr Ste B190, Miami, FL 33173-5419 | 2015-01-28 |
| 1710263827 | Pablo Schapiro | Pediatrics | 13671 Granada Mist Way, Delray Beach, FL 33446-5614 | 2011-11-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.