Individual
SHIVANI MITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5005 PORT ST JOHN PKWY, 2500, PORT ST JOHN, FL 32927-4305
(321) 690-0164
(321) 690-2591
Mailing address
PO BOX 850001, ORLANDO, FL 32885-0001
(321) 268-6111
(321) 268-0125
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME101697
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000036200
—
FL
Enumeration date
09/01/2005
Last updated
08/23/2010
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