Healthcare Provider Details

I. General information

NPI: 1467450080
Provider Name (Legal Business Name): SANJIV PRAVIN AMIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34041 US HIGHWAY 19 N SUITE A
PALM HARBOR FL
34684-2648
US

IV. Provider business mailing address

34041 US HIGHWAY 19 N SUITE A
PALM HARBOR FL
34684-2648
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-0017
  • Fax: 727-786-7521
Mailing address:
  • Phone: 727-786-0017
  • Fax: 727-786-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS8939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: