Healthcare Provider Details

I. General information

NPI: 1891099032
Provider Name (Legal Business Name): PHYSICIANS FOR A COMMUNITY UNITED FOR RESEARCH AND EDUCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W ROBERTSON ST
BRANDON FL
33511-4921
US

IV. Provider business mailing address

PO BOX 19633
JACKSONVILLE FL
32245-9633
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6339
  • Fax: 813-661-6442
Mailing address:
  • Phone: 904-346-3338
  • Fax: 904-346-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM B PARYANI
Title or Position: PRESIDENT
Credential: MD
Phone: 904-346-3338