Healthcare Provider Details

I. General information

NPI: 1144750258
Provider Name (Legal Business Name): SWETABEN PATIDAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 5TH AVE N
ST PETERSBURG FL
33713-7218
US

IV. Provider business mailing address

5260 78TH AVE N UNIT 2616
PINELLAS PARK FL
33780-8106
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-6768
  • Fax: 727-327-8741
Mailing address:
  • Phone: 727-321-6768
  • Fax: 727-327-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME146933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: