Provider Demographics
NPI:1053426791
Name:SHETTY, RANJITH M (MD)
Entity type:Individual
Prefix:DR
First Name:RANJITH
Middle Name:M
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 MAIN ST
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2536
Mailing Address - Country:US
Mailing Address - Phone:727-841-8876
Mailing Address - Fax:727-843-8508
Practice Address - Street 1:5307 MAIN ST
Practice Address - Street 2:SUITE # 201
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2536
Practice Address - Country:US
Practice Address - Phone:727-841-8876
Practice Address - Fax:727-843-8508
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053719207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030001113OtherR.R.MEDICARE
FL212464001OtherCIGNA
FLGHIOther0099193
FLBC/BSOther10133
FL0818171OtherAETNA
FL063584700Medicaid
FLAVMEDOther218996
FLE49849Medicare UPIN
FL10133Medicare ID - Type Unspecified