Provider Demographics
NPI:1477885002
Name:SHARAD R LAKDAWALA M.D., PA
Entity Type:Organization
Organization Name:SHARAD R LAKDAWALA M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAKDAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-935-4145
Mailing Address - Street 1:2908 W WATERS AVE
Mailing Address - Street 2:SUITE#101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1874
Mailing Address - Country:US
Mailing Address - Phone:813-935-4145
Mailing Address - Fax:813-935-0550
Practice Address - Street 1:2908 W WATERS AVE
Practice Address - Street 2:SUITE#101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1874
Practice Address - Country:US
Practice Address - Phone:813-935-4145
Practice Address - Fax:813-935-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 382022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065892800Medicaid
FL30367Medicare PIN