1750492195 NPI number — SHRIKANTH UPADYA MD

Table of content: SHRIKANTH UPADYA MD (NPI 1750492195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750492195 NPI number — SHRIKANTH UPADYA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UPADYA
Provider First Name:
SHRIKANTH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1750492195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 OLD CAMP RD 270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-633-1966
Provider Business Mailing Address Fax Number:
352-633-1969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 OLD CAMP RD
Provider Second Line Business Practice Location Address:
STE 270
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32162-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-633-1966
Provider Business Practice Location Address Fax Number:
352-633-1969
Provider Enumeration Date:
08/31/2006

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: 207RC0000X , with the licence number:  ME0096882 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: ME96882 , 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: 278696600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11436483 . This is a "CAQH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 91155 . This is a "BCBS OF FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME96882 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00384632 . This is a "MEDICARE RR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1213382 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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