Healthcare Provider Details

I. General information

NPI: 1467148304
Provider Name (Legal Business Name): SHRUTI SANJAY VAGHASIA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 07/01/2023
Certification Date: 07/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4073 FESTIVAL POINTE BLVD
MULBERRY FL
33860-4514
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7785
  • Fax:
Mailing address:
  • Phone: 863-274-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberUO9359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: