Provider Demographics
NPI:1619229515
Name:WISEBUDDHA ENTERPRISES
Entity Type:Organization
Organization Name:WISEBUDDHA ENTERPRISES
Other - Org Name:SHAH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:352-222-9636
Mailing Address - Street 1:7550 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7607
Mailing Address - Country:US
Mailing Address - Phone:352-235-9636
Mailing Address - Fax:877-465-6936
Practice Address - Street 1:7550 W UNIVERSITY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7607
Practice Address - Country:US
Practice Address - Phone:352-235-9636
Practice Address - Fax:877-465-6936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 225100000X, 261QR0404X, 291U00000X
FLME107485207R00000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty