Provider Demographics
NPI:1700823846
Name:UPADHYAY, SHITAL-HITEN JITENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SHITAL-HITEN
Middle Name:JITENDRA
Last Name:UPADHYAY
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 1:640 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7126
Mailing Address - Country:US
Mailing Address - Phone:727-528-7827
Mailing Address - Fax:
Practice Address - Street 1:640 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7126
Practice Address - Country:US
Practice Address - Phone:727-528-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80430207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL930093707OtherRAILROAD MEDICARE
H18190Medicare UPIN
FLE4242OMedicare PIN
FLE4242VMedicare PIN
FLE4242ZMedicare PIN