Provider Demographics
NPI:1528151321
Name:BHATIA, SHIVANK (MD)
Entity type:Individual
Prefix:
First Name:SHIVANK
Middle Name:
Last Name:BHATIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 E STONEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-1293
Mailing Address - Country:US
Mailing Address - Phone:305-979-9602
Mailing Address - Fax:469-405-4958
Practice Address - Street 1:13722 S JOG RD STE A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-5909
Practice Address - Country:US
Practice Address - Phone:561-560-0723
Practice Address - Fax:469-405-4958
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFC16022085R0204X
FLME1009452085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2769310-00Medicaid
FL2769310-00Medicaid