Provider Demographics
NPI:1689643199
Name:NARAIN, SHAKTI (MD)
Entity Type:Individual
Prefix:
First Name:SHAKTI
Middle Name:
Last Name:NARAIN
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 1:1070 FLAGLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748
Mailing Address - Country:US
Mailing Address - Phone:352-365-2550
Mailing Address - Fax:352-365-1950
Practice Address - Street 1:1070 FLAGLER AVENUE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-365-2550
Practice Address - Fax:352-365-1950
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56590207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061991400Medicaid
FL09549OtherBCBS
09549Medicare ID - Type Unspecified
FL061991400Medicaid