1962471797 NPI number — KRISH B SHROFF MD

Table of content: KRISH B SHROFF MD (NPI 1962471797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962471797 NPI number — KRISH B SHROFF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHROFF
Provider First Name:
KRISH
Provider Middle Name:
B
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:
SHROFF
Provider Other First Name:
KRISHANAVADAN
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962471797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8219 LYNCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32835-5901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-217-5700
Provider Business Mailing Address Fax Number:
407-258-8263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 RAYMOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32803-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-629-1599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2006

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: 207Q00000X , with the licence number:  ME32254 , 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: 043815400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".