Individual
DR. NANA S AMIRIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
1251 S HICKORY ST, MELBOURNE, FL 32901-3221
(321) 434-3420
(321) 434-3423
Mailing address
PO BOX 561600, ROCKLEDGE, FL 32956-1600
(321) 434-4660
(321) 259-0635
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
ME105768
FL
2085R0202X
Diagnostic Radiology Physician
D0060165
MD
2085R0204X
Vascular & Interventional Radiology Physician
ME105768
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001680100
—
FL
01
—
0063
CAREFIRST BCBS
DC
05
—
405376100
—
MD
01
—
60340002
CAREFIRST BCBS
MD
Enumeration date
09/23/2005
Last updated
01/02/2013
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