Healthcare Provider Details

I. General information

NPI: 1619229515
Provider Name (Legal Business Name): WISEBUDDHA ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 W UNIVERSITY AVE SUITE B
GAINESVILLE FL
32607-7607
US

IV. Provider business mailing address

7550 W UNIVERSITY AVE SUITE B
GAINESVILLE FL
32607-7607
US

V. Phone/Fax

Practice location:
  • Phone: 352-235-9636
  • Fax: 877-465-6936
Mailing address:
  • Phone: 352-235-9636
  • Fax: 877-465-6936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberME107485
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0404X
TaxonomyCardiac Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME107485
License Number StateFL

VIII. Authorized Official

Name: DR. MAULIK SHAH
Title or Position: CEO
Credential: MD PHD
Phone: 352-222-9636