Healthcare Provider Details

I. General information

NPI: 1366929630
Provider Name (Legal Business Name): ANSH KRISHNACHANDRA MEHTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100276
GAINESVILLE FL
32610-0276
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7955
  • Fax: 352-265-7996
Mailing address:
  • Phone: 352-265-7955
  • Fax: 352-265-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME173990
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberL4830R
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL4830R
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME173990
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME173990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: