Provider Demographics
NPI:1528004033
Name:VENKAT, SHWETA R (MD)
Entity Type:Individual
Prefix:
First Name:SHWETA
Middle Name:R
Last Name:VENKAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8780
Mailing Address - Country:US
Mailing Address - Phone:863-494-6599
Mailing Address - Fax:863-494-5467
Practice Address - Street 1:830 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8780
Practice Address - Country:US
Practice Address - Phone:863-494-6599
Practice Address - Fax:863-494-5467
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81101OtherBLUE CROSS BLUE SHIELD
FLU8298ZMedicare PIN
FL81101OtherBLUE CROSS BLUE SHIELD