MEDICARE: VALRICO MEDICAL CARE, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	OS0003202	FL

General Provider Information

NPI Number	:	1205025277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALRICO MEDICAL CARE, P.A.

Provider Business Mailing Address
First Line	:	143 N OAKWOOD AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4629
Country	:	US
Telephone Number	:	813-685-4617
Fax Number	:	813-685-7105

Provider Business Practice Location Address
First Line	:	143 N OAKWOOD AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33510-4629
Country	:	US
Telephone Number	:	813-685-4617
Fax Number	:	813-685-7105

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DIPAK SHAH
Credential	:	M.D.
Telephone Number	:	813-265-2066

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	07/29/2010

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