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General NPI Number Information
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NPI Number | 1447447313
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Entity Type | Organization
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Legal Business Name | WESLEY CHAPEL INTERNAL MEDICINE AND PEDIATRICS, PA
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 2038 ASHLEY OAKS CIR SUITE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6413
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Country | US
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Telephone | 813-929-3622
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Fax | 813-929-3620
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Provider Business Mailing Address
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Address Line | 2038 ASHLEY OAKS CIR SUITE 102
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6413
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Country | US
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Telephone | 813-929-3622
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Fax | 813-929-3620
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MANISH SHAH
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Credential | MD
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Telephone | 813-929-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME81346
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME81346
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License Number State | FL
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