Provider Demographics
NPI:1811906779
Name:NANAVATI, SHARDUL ASHWIN (MD)
Entity type:Individual
Prefix:DR
First Name:SHARDUL
Middle Name:ASHWIN
Last Name:NANAVATI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4760 TAMIAMI TRAIL N
Mailing Address - Street 2:SUITE 27
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103
Mailing Address - Country:US
Mailing Address - Phone:239-593-9599
Mailing Address - Fax:239-593-4099
Practice Address - Street 1:4760 TAMIAMI TRAIL NORTH
Practice Address - Street 2:SUITE 27
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3884
Practice Address - Country:US
Practice Address - Phone:239-593-9599
Practice Address - Fax:239-593-4099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME92248207RG0100X
TXL4590207RG0100X
GA055773207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033581638AMedicaid
GA033581638AMedicaid
GAI125296Medicare UPIN