MEDICARE: SOUTHWEST FLORIDA RHEUMATOLOGY LLC

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	332900000X	Non-Pharmacy Dispensing Site
2	207RR0500X	Rheumatology Physician	ME 96110	FL

General Provider Information

NPI Number	:	1871645119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FLORIDA RHEUMATOLOGY LLC

Provider Business Mailing Address
First Line	:	11954 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:	813-672-2243
Fax Number	:	813-672-2245

Provider Business Practice Location Address
First Line	:	11954 BOYETTE RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33569-5601
Country	:	US
Telephone Number	:	813-672-2243
Fax Number	:	813-672-2245

Authorized Official
Title or Position	:	OWNER
Name	:	SHANMUGAPRIYA REDDY
Credential	:
Telephone Number	:	813-672-2243

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	05/05/2026

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