Provider Demographics
NPI:1730725086
Name:SHELADIYA, UTTAM
Entity type:Individual
Prefix:
First Name:UTTAM
Middle Name:
Last Name:SHELADIYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 NW 68TH AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7542
Mailing Address - Country:US
Mailing Address - Phone:302-401-7494
Mailing Address - Fax:
Practice Address - Street 1:12080 SOUTH JOG ROD
Practice Address - Street 2:
Practice Address - City:BOYTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-733-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist