Healthcare Provider Details

I. General information

NPI: 1710936695
Provider Name (Legal Business Name): RAJANI P.V. SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8702 HUNTERS LAKE DR STE 100
TAMPA FL
33647-2855
US

IV. Provider business mailing address

2700 HEALING WAY STE 112
WESLEY CHAPEL FL
33543-5453
US

V. Phone/Fax

Practice location:
  • Phone: 813-467-4700
  • Fax: 813-467-4261
Mailing address:
  • Phone: 813-929-5330
  • Fax: 813-929-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME71862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: