Provider Demographics
NPI:1447213947
Name:PURANIK, UJWALA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:UJWALA
Middle Name:P
Last Name:PURANIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:UJWALA
Other - Middle Name:D
Other - Last Name:SHETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 8TH AVE W STE 101
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4737
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:
Practice Address - Street 1:1515 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7707
Practice Address - Country:US
Practice Address - Phone:941-708-8600
Practice Address - Fax:941-708-7645
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001198498Medicaid