Individual
DR. SHIVA PRASAD SHASHIDHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17000 PORTER RD STE 201, WINTER GARDEN, FL 34787-8915
(321) 841-6444
(407) 290-2118
Mailing address
17000 PORTER RD STE 201, WINTER GARDEN, FL 34787-8915
(321) 841-6444
(407) 290-2118
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
036137703
IL
207RC0000X
Cardiovascular Disease Physician
Primary
ME160523
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120759600
—
FL
Enumeration date
08/11/2012
Last updated
02/01/2024
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