Healthcare Provider Details

I. General information

NPI: 1902835176
Provider Name (Legal Business Name): SHAHNAZ PUNJANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 SUN N LAKE BLVD STE 202
SEBRING FL
33872
US

IV. Provider business mailing address

4240 SUN N LAKE BLVD STE 202
SEBRING FL
33872-1944
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-3926
  • Fax: 863-385-3093
Mailing address:
  • Phone: 863-471-3926
  • Fax: 863-385-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME129265
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME129265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: