Provider Demographics
NPI:1689930208
Name:JETHWA, NEEL MANJI (MD)
Entity Type:Individual
Prefix:DR
First Name:NEEL
Middle Name:MANJI
Last Name:JETHWA
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 1:1503 DR. MLK STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4201
Mailing Address - Country:US
Mailing Address - Phone:727-480-4340
Mailing Address - Fax:
Practice Address - Street 1:1503 DR. MLK STREET NORTH
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4201
Practice Address - Country:US
Practice Address - Phone:727-480-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME132703207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program