Healthcare Provider Details

I. General information

NPI: 1083025258
Provider Name (Legal Business Name): SHASHANK SHEKHAR SRIVASTAVA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 S PINE AVE
OCALA FL
34471-6543
US

IV. Provider business mailing address

PO BOX 25317
TAMPA FL
33622-5317
US

V. Phone/Fax

Practice location:
  • Phone: 352-368-2238
  • Fax: 352-368-5042
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD193284
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberCDR.0002547
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60912451
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number62045
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME167604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: