1053426791 NPI number — DR. RANJITH M SHETTY M.D.

Table of content: DR. RANJITH M SHETTY M.D. (NPI 1053426791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053426791 NPI number — DR. RANJITH M SHETTY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHETTY
Provider First Name:
RANJITH
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053426791
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5307 MAIN ST
Provider Second Line Business Mailing Address:
SUITE # 201
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34652-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-841-8876
Provider Business Mailing Address Fax Number:
727-843-8508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5307 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE # 201
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-2536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-841-8876
Provider Business Practice Location Address Fax Number:
727-843-8508
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207KA0200X , with the licence number:  ME0053719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 030001113 . This is a "R.R.MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 212464001 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: GHI . This is a "0099193" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: BC/BS . This is a "10133" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0818171 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 063584700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: AVMED . This is a "218996" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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