Basic Information
| Provider Information | |||||||||
| NPI: | 1871584342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARYANI | ||||||||
| FirstName: | SHYAM | ||||||||
| MiddleName: | BHOJRAJ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS DEPT. | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 2161 KINGSLEY AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320735116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042762303 | ||||||||
| FaxNumber: | 9042769690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 03/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | ME39857 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1115828 | 01 | FL | CARE PLUS | OTHER | P01451917 | 01 | FL | RR MEDICARE | OTHER | P01782052 | 01 | FL | RR MEDICARE | OTHER | 209686 | 01 | FL | AVMED | OTHER | 000274414A | 05 | GA | MEDICAID | 043712300 | 05 | FL | MEDICAID | 1119090 | 01 | FL | WELLCARE | OTHER | P00201839 | 01 | FL | MEDICARE RAILROAD | OTHER | 15752 | 01 | FL | BCBS | OTHER | 1193431 | 01 | FL | WELLCARE | OTHER | P01596530 | 01 | FL | RR MEDICARE | OTHER | 1733767 | 01 | FL | CIGNA | OTHER | 4045046 | 01 | FL | AETNA | OTHER |