Provider Demographics
NPI:1629226782
Name:BHALEEYA, SWETANGI D (MD)
Entity Type:Individual
Prefix:
First Name:SWETANGI
Middle Name:D
Last Name:BHALEEYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWETANGIBEN
Other - Middle Name:D
Other - Last Name:BHALEEYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13127 USF MAGNOLIA DR
Practice Address - Street 2:MDC21
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-974-3820
Practice Address - Fax:813-974-5621
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 110270207W00000X
NY265063207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003931800Medicaid
FL14F57OtherBLUE CROSS BLUE SHIELD
FL14F57OtherBLUE CROSS BLUE SHIELD