Provider Demographics
NPI:1548249535
Name:BAKSHI, SHAKTI DATT (MD)
Entity type:Individual
Prefix:DR
First Name:SHAKTI
Middle Name:DATT
Last Name:BAKSHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6550 N WICKHAM RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2038
Mailing Address - Country:US
Mailing Address - Phone:321-255-1947
Mailing Address - Fax:321-255-5343
Practice Address - Street 1:6550 N WICKHAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2038
Practice Address - Country:US
Practice Address - Phone:321-255-1947
Practice Address - Fax:321-255-5343
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME77840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2507ZMedicare ID - Type UnspecifiedMEDICARE ID
FLG36371Medicare UPIN