Individual
DR. KALYANI MANJUL DERASARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4202 E FOWLER AVE, SHS-100, TAMPA, FL 33620-9951
(813) 974-2331
(813) 974-7181
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME52057
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000199700
—
FL
01
—
05667
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/24/2008
Last updated
01/04/2024
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