Healthcare Provider Details

I. General information

NPI: 1134581929
Provider Name (Legal Business Name): SHAUN RAJIV TIWARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

IV. Provider business mailing address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-0100
  • Fax:
Mailing address:
  • Phone: 850-216-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: