Provider Demographics
NPI:1497723480
Name:SARNAIK, SHAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:
Last Name:SARNAIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 58TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1326
Mailing Address - Country:US
Mailing Address - Phone:727-822-4300
Mailing Address - Fax:727-456-1399
Practice Address - Street 1:5205 EAST FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1126
Practice Address - Country:US
Practice Address - Phone:813-987-2911
Practice Address - Fax:813-987-2853
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002986900Medicaid
OHQ48622Medicare UPIN
FL002986900Medicaid