Provider Demographics
NPI:1871584342
Name:PARYANI, SHYAM BHOJRAJ (MD)
Entity type:Individual
Prefix:
First Name:SHYAM
Middle Name:BHOJRAJ
Last Name:PARYANI
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2161 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5116
Practice Address - Country:US
Practice Address - Phone:904-276-2303
Practice Address - Fax:904-276-9690
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME398572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1115828OtherCARE PLUS
FLP01451917OtherRR MEDICARE
FLP01782052OtherRR MEDICARE
FL209686OtherAVMED
GA000274414AMedicaid
FL043712300Medicaid
FL1119090OtherWELLCARE
FLP00201839OtherMEDICARE RAILROAD
FL15752OtherBCBS
FL1193431OtherWELLCARE
FLP01596530OtherRR MEDICARE
FL1733767OtherCIGNA
FL4045046OtherAETNA
FLD52724Medicare UPIN
FLP01451917OtherRR MEDICARE
FL15752OtherBCBS
FL1193431OtherWELLCARE
FL1119090OtherWELLCARE
FLAJ074OMedicare PIN
FL15752PMedicare PIN
FLAJ074UMedicare PIN
FL15752LMedicare PIN
FL1733767OtherCIGNA
FLP01596530OtherRR MEDICARE
FLP00201839OtherMEDICARE RAILROAD
GA000274414AMedicaid
FLAJ074WMedicare PIN
FLAJ074PMedicare PIN