Provider Demographics
NPI:1326046962
Name:PATEL, SHARAD I (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARAD
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 N DALE MABRY HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3860
Mailing Address - Country:US
Mailing Address - Phone:813-238-7540
Mailing Address - Fax:813-932-7940
Practice Address - Street 1:6919 N DALE MABRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3972
Practice Address - Country:US
Practice Address - Phone:813-558-4900
Practice Address - Fax:813-932-7940
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41908207PE0005X, 2083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
020036152OtherRAILROAD MEDICARE
FL067572500Medicaid
FL00191OtherWELLCARE
FLP01108968OtherRAILROAD MEDICARE
205647OtherAMERIGROUP
FL30559OtherBCBS OF FL
204013OtherAVMED
FL30559OtherBCBS OF FL
FLP01108968OtherRAILROAD MEDICARE
FL067572500Medicaid