Healthcare Provider Details

I. General information

NPI: 1063526424
Provider Name (Legal Business Name): SHAHEEN MOTIWALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320W FLETCHER AVE 101
TAMPA FL
33612-3400
US

IV. Provider business mailing address

320W FLETCHER AVE 101
TAMPA FL
33612-3400
US

V. Phone/Fax

Practice location:
  • Phone: 813-775-2352
  • Fax:
Mailing address:
  • Phone: 813-775-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME95629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: