Individual provider Active NPI

Roshni Panchal Graydus, APRN

  • Family Nurse Practitioner
  • Clermont, FL
National Provider Identifier
1356833222
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11009475 Issued in FL
Practice address
235 Hatteras Ave Ste 100
Clermont, FL 34711-7401
Phone
(352) 717-4929
NPI assigned
Jun 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 810019 NV
Family Nurse Practitioner 363LF0000X APRN11009475 FL Primary

Addresses

Primary practice location

235 Hatteras Ave Ste 100
Clermont, FL 34711-7401

Mailing address

235 Hatteras Ave Ste 100
Clermont, FL 34711-7401
Phone (352) 717-4929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240209000086 FL Practitioner - Nurse Practitioner 5698021046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN11009475FLMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716940800000",
    "number": "1356833222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 HATTERAS AVE STE 100",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347117401",
            "telephone_number": "352-717-4929",
            "fax_number": "352-717-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 HATTERAS AVE STE 100",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347117401",
            "telephone_number": "352-717-4929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYDUS",
        "first_name": "ROSHNI",
        "middle_name": "PANCHAL",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-05",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "810019",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11009475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.