Healthcare Provider Details

I. General information

NPI: 1871645119
Provider Name (Legal Business Name): SOUTHWEST FLORIDA RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11954 BOYETTE RD
RIVERVIEW FL
33569-5601
US

IV. Provider business mailing address

11954 BOYETTE RD
RIVERVIEW FL
33569-5601
US

V. Phone/Fax

Practice location:
  • Phone: 813-672-2243
  • Fax: 813-672-2245
Mailing address:
  • Phone: 813-672-2243
  • Fax: 813-672-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME 96110
License Number StateFL

VIII. Authorized Official

Name: SHANMUGAPRIYA REDDY
Title or Position: OWNER
Credential:
Phone: 813-672-2243