Healthcare Provider Details

I. General information

NPI: 1083545339
Provider Name (Legal Business Name): SHANTINATH VILLAGES PULMONARY AND SLEEP CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 NE 138TH LN BLDG 600
LADY LAKE FL
32159-6816
US

IV. Provider business mailing address

1670 N JIMMIE FOXX PATH
HERNANDO FL
34442-5181
US

V. Phone/Fax

Practice location:
  • Phone: 423-747-6025
  • Fax:
Mailing address:
  • Phone: 423-747-6025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GAURAV SHAH
Title or Position: OWNER
Credential: MD
Phone: 423-747-6025