Rezia Catherine Shobhana Divaker, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME96675 Issued in FL

Practice address

6551 N Orange Blossom TRL
Ste# 229
Mount Dora, FL 32757-7013

Phone

(352) 383-8384

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shobhana Rezia Catherine Joseph Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CBHCCA/Endpoint/CBHCCA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Divaker Pediatrics LLC

  • Pediatrics Physician
  • Mount Dora, FL
  • NPI 1518302835
  NPD (past) Authorized official

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376524800000",
    "number": "1376635409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13506 SUMMERPORT VILLAGE PKWY",
            "address_2": "STE# 334",
            "city": "WINDERMERE",
            "state": "FL",
            "postal_code": "347867366",
            "telephone_number": "352-383-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6551 N ORANGE BLOSSOM TRL",
            "address_2": "STE# 229",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327577013",
            "telephone_number": "352-383-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVAKER",
        "first_name": "REZIA",
        "middle_name": "CATHERINE SHOBHANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2013-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME96675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008731900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "56693",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHOBHANA",
            "last_name": "JOSEPH",
            "middle_name": "REZIA CATHERINE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Samuel Mark Dickinson
• Sebastian Dickson
• Tiffany Lee Dickson, MSW
• Rebecca Diel
• Divaker Pediatrics LLC
• Samuel S Divaker, MD
• Kenya Dixon, PHARMD
• Wilfort Doly, LMT
• Wendy Donald
• Dr. Daniel Thomas, Inc.

• Pediatrics Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.