Provider Demographics
NPI:1043347990
Name:DIPTEE RODRIGUES, JEEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEEVAN
Middle Name:
Last Name:DIPTEE RODRIGUES
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 1:810 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-1017
Mailing Address - Country:US
Mailing Address - Phone:727-743-9158
Mailing Address - Fax:
Practice Address - Street 1:810 116TH AVE
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-1017
Practice Address - Country:US
Practice Address - Phone:727-743-9158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL898562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270141300Medicaid
FL113456Medicare UPIN