Healthcare Provider Details

I. General information

NPI: 1447447313
Provider Name (Legal Business Name): WESLEY CHAPEL INTERNAL MEDICINE AND PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 ASHLEY OAKS CIR SUITE 102
WESLEY CHAPEL FL
33544-6413
US

IV. Provider business mailing address

2038 ASHLEY OAKS CIR SUITE 102
WESLEY CHAPEL FL
33544-6413
US

V. Phone/Fax

Practice location:
  • Phone: 813-929-3622
  • Fax: 813-929-3620
Mailing address:
  • Phone: 813-929-3622
  • Fax: 813-929-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME81346
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME81346
License Number StateFL

VIII. Authorized Official

Name: DR. MANISH SHAH
Title or Position: DOCTOR
Credential: MD
Phone: 813-929-3622