Healthcare Provider Details

I. General information

NPI: 1124811468
Provider Name (Legal Business Name): SHALINI STANI PATHYIL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 FALLEN LEAF DR
RIVERVIEW FL
33578-4739
US

IV. Provider business mailing address

5113 FALLEN LEAF DR
RIVERVIEW FL
33578-4739
US

V. Phone/Fax

Practice location:
  • Phone: 813-469-8995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: