Healthcare Provider Details

I. General information

NPI: 1902154859
Provider Name (Legal Business Name): SHUBHA KOLLAMPARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 HARTWOOD MARSH RD STE 3
CLERMONT FL
34711-5390
US

IV. Provider business mailing address

2105 HARTWOOD MARSH RD STE 3
CLERMONT FL
34711-5390
US

V. Phone/Fax

Practice location:
  • Phone: 347-216-5347
  • Fax:
Mailing address:
  • Phone: 352-810-9073
  • Fax: 352-810-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME153239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: