Provider Demographics
NPI:1073845459
Name:SHAKTI NARAIN MD PA
Entity Type:Organization
Organization Name:SHAKTI NARAIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BINDOO
Authorized Official - Middle Name:
Authorized Official - Last Name:NARAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-365-2550
Mailing Address - Street 1:1070 FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7633
Mailing Address - Country:US
Mailing Address - Phone:352-365-2550
Mailing Address - Fax:352-365-1950
Practice Address - Street 1:1070 FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7633
Practice Address - Country:US
Practice Address - Phone:352-365-2550
Practice Address - Fax:352-365-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56590207R00000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061991400Medicaid
FLC65184Medicare UPIN