Provider Demographics
NPI:1720303555
Name:SHETTY, ANJALI
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:SHETTY
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 1:33920 US 19 N STE 241
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2672
Mailing Address - Country:US
Mailing Address - Phone:727-773-9793
Mailing Address - Fax:727-773-0674
Practice Address - Street 1:33920 US 19 N STE 241
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2672
Practice Address - Country:US
Practice Address - Phone:727-773-9793
Practice Address - Fax:727-773-0674
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121856207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593548577OtherTAXPAYER IDENTIFICATION NUMBER
FLIE054ZMedicare PIN