Healthcare Provider Details

I. General information

NPI: 1639153158
Provider Name (Legal Business Name): SHILPA P SAXENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19105 US HIGHWAY 41 N SUITE 100
LUTZ FL
33549-4258
US

IV. Provider business mailing address

19105 US HIGHWAY 41 N SUITE 100
LUTZ FL
33549-4258
US

V. Phone/Fax

Practice location:
  • Phone: 813-269-2700
  • Fax: 813-269-2701
Mailing address:
  • Phone: 813-269-2700
  • Fax: 813-269-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME79414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: