Healthcare Provider Details

I. General information

NPI: 1700572047
Provider Name (Legal Business Name): SHIVANI VIJAY PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

14000 FIVAY RD
HUDSON FL
34667-7103
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-2929
  • Fax:
Mailing address:
  • Phone: 727-819-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME181482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: