Healthcare Provider Details

I. General information

NPI: 1437841897
Provider Name (Legal Business Name): SHIVANI MATHURA CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-2135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number182802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: