Individual
DR. SHOBA THEIVANAYAGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
812 W OAK ST, KISSIMMEE, FL 34741-6625
(407) 201-3686
(407) 201-3739
Mailing address
PO BOX 782009, ORLANDO, FL 32878-2009
(407) 201-3686
(407) 201-3739
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME148442
FL
Other
Enumeration date
07/17/2007
Last updated
10/27/2021
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