Healthcare Provider Details

I. General information

NPI: 1386393585
Provider Name (Legal Business Name): SHIVANG NARENDRAKUMAR BHAKTA BHAKTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST FL 58
PITTSBURGH PA
15219-2739
US

IV. Provider business mailing address

600 GRANT ST FL 58
PITTSBURGH PA
15219-2739
US

V. Phone/Fax

Practice location:
  • Phone: 724-678-1692
  • Fax: 412-864-7708
Mailing address:
  • Phone: 724-678-1692
  • Fax: 412-864-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD494380
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: