MEDICARE: FIRST COAST ALLERGY AND ASTHMA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	ME87944	FL

General Provider Information

NPI Number	:	1083668511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST ALLERGY AND ASTHMA PA

Provider Business Mailing Address
First Line	:	9838 OLD BAYMEADOWS RD
Second Line	:	PMB #358
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-8101
Country	:	US
Telephone Number	:	904-642-9001
Fax Number	:	904-642-9150

Provider Business Practice Location Address
First Line	:	9191 R.G. SKINNER PARKWAY
Second Line	:	SUITE 402
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9179
Country	:	US
Telephone Number	:	904-642-9001
Fax Number	:	904-642-9150

Authorized Official
Title or Position	:	OWNER
Name	:	SANJAY SWAMI
Credential	:	M.D.
Telephone Number	:	904-642-9001

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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Directions to “FIRST COAST ALLERGY AND ASTHMA PA ” Practice Location

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