Provider Demographics
NPI:1023193414
Name:SHETYE, BHARTI MADAN (MD)
Entity Type:Individual
Prefix:
First Name:BHARTI
Middle Name:MADAN
Last Name:SHETYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHARTI
Other - Middle Name:MADAN
Other - Last Name:ABICHANDANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:205 DR MLK JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-824-6900
Mailing Address - Fax:843-887-3929
Practice Address - Street 1:1609 PASADENA AVE S STE 3M
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4563
Practice Address - Country:US
Practice Address - Phone:727-289-7137
Practice Address - Fax:727-498-6418
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23516207R00000X
FLME96556207R00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94805Medicare UPIN
SCH94805Medicare UPIN