Healthcare Provider Details

I. General information

NPI: 1205749520
Provider Name (Legal Business Name): SHIV MISTRY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 W COLONIAL DR
OCOEE FL
34761-2979
US

IV. Provider business mailing address

10956 W COLONIAL DR
OCOEE FL
34761-2979
US

V. Phone/Fax

Practice location:
  • Phone: 352-428-3287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: