Provider Demographics
NPI:1285796078
Name:VITKO SHULLA, PATRICIA D (DPM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:VITKO SHULLA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DENISE
Other - Last Name:VITKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1818 HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3605
Mailing Address - Country:US
Mailing Address - Phone:941-952-0669
Mailing Address - Fax:
Practice Address - Street 1:1818 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3605
Practice Address - Country:US
Practice Address - Phone:941-952-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01346213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87706Medicare ID - Type Unspecified
FL87706Medicare PIN
FL0554800001Medicare NSC
T55511Medicare UPIN