Provider Demographics
NPI:1366055311
Name:SHOT HEALTH LLC
Entity type:Organization
Organization Name:SHOT HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AKHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-906-5020
Mailing Address - Street 1:10845 STANDING STONE DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-6162
Mailing Address - Country:US
Mailing Address - Phone:813-906-5020
Mailing Address - Fax:
Practice Address - Street 1:10845 STANDING STONE DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-6162
Practice Address - Country:US
Practice Address - Phone:813-906-5020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty