Healthcare Provider Details

I. General information

NPI: 1366540502
Provider Name (Legal Business Name): SHIRISKUMAR G PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 N. FLORIDA AVE.
HERNANDO FL
34442
US

IV. Provider business mailing address

2669 N FLORIDA AVE
HERNANDO FL
34442-4331
US

V. Phone/Fax

Practice location:
  • Phone: 352-637-2550
  • Fax: 352-637-2551
Mailing address:
  • Phone: 352-637-2550
  • Fax: 352-637-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME50533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: