Provider Demographics
NPI:1548601412
Name:SHAH, NIKITA BHAKTA (DO)
Entity Type:Individual
Prefix:DR
First Name:NIKITA
Middle Name:BHAKTA
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NIKITA
Other - Middle Name:BHUPENDRA
Other - Last Name:BHAKTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11954 NARCOOSEE ROAD
Mailing Address - Street 2:SUITE 2, #204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-8202
Mailing Address - Country:US
Mailing Address - Phone:850-499-3512
Mailing Address - Fax:407-303-8659
Practice Address - Street 1:7656 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8237
Practice Address - Country:US
Practice Address - Phone:407-996-4554
Practice Address - Fax:407-996-4064
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13183207QB0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty