Healthcare Provider Details

I. General information

NPI: 1477787638
Provider Name (Legal Business Name): SHRUTI NIKETAN TEWAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2009
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 LEE RD
WINTER PARK FL
32789-1755
US

IV. Provider business mailing address

2435 LEE RD
WINTER PARK FL
32789-1755
US

V. Phone/Fax

Practice location:
  • Phone: 407-564-3375
  • Fax: 407-564-3379
Mailing address:
  • Phone: 407-564-3375
  • Fax: 407-564-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME171901
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberE-13828
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: