Healthcare Provider Details

I. General information

NPI: 1619506755
Provider Name (Legal Business Name): SHRUTI KISHOR SHETTIGAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 FUTURES DR STE 17
ORLANDO FL
32819-9084
US

IV. Provider business mailing address

7350 FUTURES DR STE 17
ORLANDO FL
32819-9084
US

V. Phone/Fax

Practice location:
  • Phone: 321-214-0028
  • Fax:
Mailing address:
  • Phone: 321-214-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME182477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: