Provider Demographics
NPI:1043273600
Name:PANDYA, SHREYASH N (MD)
Entity Type:Individual
Prefix:
First Name:SHREYASH
Middle Name:N
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2114
Mailing Address - Country:US
Mailing Address - Phone:727-521-5066
Mailing Address - Fax:727-521-5137
Practice Address - Street 1:6000 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2114
Practice Address - Country:US
Practice Address - Phone:727-521-5066
Practice Address - Fax:727-521-5137
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI071114207ZP0102X
FLME111085207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI220033235OtherRRMC
MI4438699Medicaid
MI2204602122OtherBS
OHPA4235741Medicare PIN
MI220033235OtherRRMC