Healthcare Provider Details

I. General information

NPI: 1558855114
Provider Name (Legal Business Name): MICHELLE SHIWCHARAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2569 COUNTRYSIDE BLVD STE 20
CLEARWATER FL
33761-3581
US

IV. Provider business mailing address

16620 ASHTON GREEN DR
LUTZ FL
33558-4919
US

V. Phone/Fax

Practice location:
  • Phone: 813-293-0512
  • Fax:
Mailing address:
  • Phone: 813-293-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9330562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: