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General NPI Number Information
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NPI Number | 1548818073
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Entity Type | Organization
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Legal Business Name | BRANDON MEDICAL CARE LLC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 143 N OAKWOOD AVE
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City | BRANDON
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State | FL
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Zip | 33510-4629
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Country | US
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Telephone | 813-734-8939
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Fax |
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Provider Business Mailing Address
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Address Line | 6328 GUNN HWY STE B33624
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City | TAMPA
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State | FL
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Zip | 33625-4101
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Country | US
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Telephone | 813-964-8526
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHITAL MEHTA
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Credential | D.O.
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Telephone | 813-734-8939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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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 |
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License Number State |
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