Provider Demographics
NPI:1013967306
Name:JANOVITZ PARRILLO DELGADO & SHAH MD PA
Entity type:Organization
Organization Name:JANOVITZ PARRILLO DELGADO & SHAH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-992-7740
Mailing Address - Street 1:2863 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5412
Mailing Address - Country:US
Mailing Address - Phone:407-843-1620
Mailing Address - Fax:407-843-5243
Practice Address - Street 1:2863 S DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5412
Practice Address - Country:US
Practice Address - Phone:407-843-1620
Practice Address - Fax:407-843-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38240OtherBLUE CROSS BLUE SHIELD
FL=========OtherTAX ID
FLK0361Medicare ID - Type Unspecified