Provider Demographics
NPI:1467450080
Name:AMIN, SANJIV PRAVIN (DO)
Entity type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:PRAVIN
Last Name:AMIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34041 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2648
Mailing Address - Country:US
Mailing Address - Phone:727-786-0017
Mailing Address - Fax:727-786-7521
Practice Address - Street 1:34041 US HIGHWAY 19 N
Practice Address - Street 2:SUITE A
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2648
Practice Address - Country:US
Practice Address - Phone:727-786-0017
Practice Address - Fax:727-786-7521
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8939174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267419000Medicaid
FLH03594Medicare UPIN
FL81246ZMedicare PIN