Provider Demographics
NPI:1083110571
Name:DOSI, SHRUTI (DPM)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:DOSI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 S INTERNATIONAL PKWY STE 1061
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1412
Mailing Address - Country:US
Mailing Address - Phone:407-323-1234
Mailing Address - Fax:
Practice Address - Street 1:1307 S INTERNATIONAL PKWY STE 1061
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1412
Practice Address - Country:US
Practice Address - Phone:407-323-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4146213E00000X, 213EP0504X, 213EP1101X, 213ES0000X, 213ES0131X, 213ES0103X
GA213E00000X213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
15165159OtherCAQH ID
FL114134200Medicaid
FLPRLE4OtherBCBS