Provider Demographics
NPI:1659634236
Name:WASTI, PRANAV (MD)
Entity Type:Individual
Prefix:DR
First Name:PRANAV
Middle Name:
Last Name:WASTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3643
Mailing Address - Country:US
Mailing Address - Phone:813-926-2177
Mailing Address - Fax:813-926-7489
Practice Address - Street 1:11924 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:813-926-2177
Practice Address - Fax:813-926-7489
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine