NPIMap

Organization Active NPI

Divani Dermatology LLC

  • Dermatology Physician
  • Sebastian, FL
National Provider Identifier
1255986113
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DIVANI DERMATOLOGY LLC
Practice address
8745 N US Highway 1
Sebastian, FL 32958-7524
Phone
(772) 217-5362
Fax
(772) 218-7267
NPI assigned
Aug 7, 2019
Last updated
Apr 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anand Haryani, MDNPI 1861812851
Title
MD/Owner
Phone
(772) 217-5362

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

8745 N US Highway 1
Sebastian, FL 32958-7524

Mailing address

8745 N US Highway 1
Sebastian, FL 32958-7524
Phone (772) 217-5362

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191008001916 FL Part B Supplier - Clinic/Group Practice 2961733803 Receives reassigned benefits from 20 practitioners
Practice locations: Sebastian, FL

National Provider Directory

National Provider Directory

Locations

311 Barefoot Blvd
Ste 1
Micco, FL 32976
Phone (772) 217-5362

8701 N US Highway 1
Ste A
Sebastian, FL 32958
Phone (772) 217-5362

8745 N US Highway 1
Sebastian, FL 32958
Phone (772) 217-5362

4800 20th St
Vero Beach, FL 32966
Phone (772) 217-5362

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1255986113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8745 N US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329587524",
            "telephone_number": "772-217-5362",
            "fax_number": "772-218-7267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8745 N US HIGHWAY 1",
            "city": "SEBASTIAN",
            "state": "FL",
            "postal_code": "329587524",
            "telephone_number": "772-217-5362",
            "fax_number": "772-218-7267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVANI DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "HARYANI",
        "authorized_official_first_name": "ANAND",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "772-217-5362",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sebastian, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.