Healthcare Provider Details

I. General information

NPI: 1558742411
Provider Name (Legal Business Name): JEET MEHTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE STE 9118
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 863-292-4004
  • Fax: 863-292-4005
Mailing address:
  • Phone: 863-292-4004
  • Fax: 863-292-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME147322
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME147322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: