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General NPI Number Information
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NPI Number | 1417729252
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Entity Type | Individual
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Provider Name | SHIVA TAJIANI PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 40215 HIGHWAY 27
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City | DAVENPORT
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State | FL
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Zip | 33837-7813
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Country | US
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Telephone | 863-421-9705
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Fax | 863-421-9779
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Provider Business Mailing Address
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Address Line | PO BOX 102222
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City | ATLANTA
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State | GA
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Zip | 30368-2222
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Country | US
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Telephone | 392-274-8200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9116917
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9116917
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9116917
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License Number State | FL
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