Provider Demographics
NPI:1295318830
Name:RAVAL, SHILPA JHOL (DO)
Entity type:Individual
Prefix:
First Name:SHILPA
Middle Name:JHOL
Last Name:RAVAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 PRIMROSE PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1017
Mailing Address - Country:US
Mailing Address - Phone:404-201-0525
Mailing Address - Fax:
Practice Address - Street 1:2850 N FEDERAL HWY FL 2
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6849
Practice Address - Country:US
Practice Address - Phone:954-942-8177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine