Provider Demographics
NPI:1144291980
Name:SINGH, SHANTI (MD)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4301
Mailing Address - Country:US
Mailing Address - Phone:407-343-4338
Mailing Address - Fax:407-343-4335
Practice Address - Street 1:1910 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4301
Practice Address - Country:US
Practice Address - Phone:407-343-4338
Practice Address - Fax:407-343-4335
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256014300Medicaid
FL256014300Medicaid
G40314Medicare UPIN