Provider Demographics
NPI:1770257792
Name:PARIKH, SHAISHAVI NITINKUMARN
Entity Type:Individual
Prefix:
First Name:SHAISHAVI
Middle Name:NITINKUMARN
Last Name:PARIKH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 LEELAND HEIGHTS BLVD W STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6662
Mailing Address - Country:US
Mailing Address - Phone:239-230-7966
Mailing Address - Fax:
Practice Address - Street 1:700 LEELAND HEIGHTS BLVD W STE 100
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6662
Practice Address - Country:US
Practice Address - Phone:239-230-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI61796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist