1861460610 NPI number — DR. SHITAL R MEHTA D.O.

Table of content: DR. SHITAL R MEHTA D.O. (NPI 1861460610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861460610 NPI number — DR. SHITAL R MEHTA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
SHITAL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEHTA
Provider Other First Name:
SHITAL
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1861460610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6328 GUNN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33625-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-964-8526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 WINDGUARD CIR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544-7366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-345-8515
Provider Business Practice Location Address Fax Number:
813-345-8517
Provider Enumeration Date:
03/09/2006

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: 207R00000X , with the licence number:  OS59391 , 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: 271714000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113967300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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