Provider Demographics
NPI:1972525087
Name:PEDIATRICS GASTROENTEROLOGY & NUTRITION OF TAMPA BAY PA
Entity type:Organization
Organization Name:PEDIATRICS GASTROENTEROLOGY & NUTRITION OF TAMPA BAY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-870-4438
Mailing Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-870-4438
Mailing Address - Fax:813-870-4153
Practice Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-870-4438
Practice Address - Fax:813-870-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME441442080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272302600Medicaid
FL272302600Medicaid