Provider Demographics
NPI:1043292683
Name:SWEZY, NISHA J (MD)
Entity Type:Individual
Prefix:
First Name:NISHA
Middle Name:J
Last Name:SWEZY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 GEORGE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7329
Mailing Address - Country:US
Mailing Address - Phone:813-496-1075
Mailing Address - Fax:813-249-7762
Practice Address - Street 1:4519 GEORGE RD
Practice Address - Street 2:STE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7329
Practice Address - Country:US
Practice Address - Phone:813-496-1075
Practice Address - Fax:813-249-7762
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000150373207L00000X
FLME103286207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209140300Medicaid
KS200000380AMedicaid
MOC36668Medicare UPIN
MO209140300Medicaid