Basic Information
| Provider Information | |||||||||
| NPI: | 1720098544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHASTRI | ||||||||
| FirstName: | MILIND | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR STE 305 | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522775348 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 N CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | INVERNESS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344533838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524196526 | ||||||||
| FaxNumber: | 3524198966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME78967 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | $$$$$$$$$ | 01 | FL | TRICARE | OTHER | 1022785 | 01 | FL | CAREPLUS-49TH STREET | OTHER | 2310456 | 01 | FL | CIGNA | OTHER | 275294800 | 05 | FL | MEDICAID | P02958 | 01 | FL | FREEDOM HEALTH | OTHER | 1842078 | 01 | FL | UNITED HEALTH CARE | OTHER | 40185826 | 01 | FL | COLORADO MEDICAID | OTHER | 49263 | 01 | FL | BLUE CROSS BLUE SHEILD OF FLORIDA | OTHER | 5450579 | 01 | FL | AETNA | OTHER | 01109877 | 01 | FL | AMERIGROUP-MEDICARE | OTHER | 11074601 | 01 | FL | CITRUS-49TH STREET | OTHER | 11074603 | 01 | FL | CITRUS-WEST BAY | OTHER | 201266825 | 01 | FL | AVALON | OTHER | 1063478 | 01 | FL | CARE PLUS-PASADENA AVE S | OTHER | 275294800 | 01 | FL | MEDIPASS | OTHER | P00192195 | 01 | FL | RAILROAD MEDICARE | OTHER | 1063479 | 01 | FL | CAREPLUS-WEST BAY | OTHER | 266778 | 01 | FL | AVMED | OTHER | 02898951 | 01 | FL | NEW YORK MEDICAID | OTHER | 11074602 | 01 | FL | CITRUS-PASADENA AVE S | OTHER | 3626316 | 01 | FL | AETNA-HMO | OTHER | USE TAX ID | 01 | FL | BEECH STREET | OTHER |