Healthcare Provider Details

I. General information

NPI: 1053426791
Provider Name (Legal Business Name): RANJITH M SHETTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 MAIN ST SUITE # 201
NEW PORT RICHEY FL
34652-2536
US

IV. Provider business mailing address

5307 MAIN ST SUITE # 201
NEW PORT RICHEY FL
34652-2536
US

V. Phone/Fax

Practice location:
  • Phone: 727-841-8876
  • Fax: 727-843-8508
Mailing address:
  • Phone: 727-841-8876
  • Fax: 727-843-8508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME0053719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: