Provider Demographics
NPI:1376578401
Name:SHETTIGAR, UDIPI RAMACHANDRA
Entity Type:Individual
Prefix:DR
First Name:UDIPI
Middle Name:RAMACHANDRA
Last Name:SHETTIGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:UDIPI
Other - Middle Name:
Other - Last Name:SHETTIGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13344 PINE BARK CT
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-5437
Mailing Address - Country:US
Mailing Address - Phone:727-595-7330
Mailing Address - Fax:
Practice Address - Street 1:BAY PINES VA HEALTH CARE SYSTEM CARDIOLOGY SECTION 111D
Practice Address - Street 2:10000 BAY PINES BLVD
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9443
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 78879207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease