Provider Demographics
NPI:1144608894
Name:PATEL, SHAMITA (MCMSC, PA-C)
Entity Type:Individual
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First Name:SHAMITA
Middle Name:
Last Name:PATEL
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Gender:F
Credentials:MCMSC, PA-C
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Mailing Address - Street 1:5210 WEBB RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4518
Mailing Address - Country:US
Mailing Address - Phone:813-882-9986
Mailing Address - Fax:813-341-3259
Practice Address - Street 1:4238 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2231
Practice Address - Country:US
Practice Address - Phone:813-879-6040
Practice Address - Fax:813-879-6043
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-04-22
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Provider Licenses
StateLicense IDTaxonomies
FLPA9108455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015960300Medicaid