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NPI Code Detail

MEDICARE: DR. ANJALI ANIL PATHAK MD

MEDICARE: DR. ANJALI ANIL PATHAK MD
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
12084P0800XPsychiatry PhysicianME62361FL
22084P0804XChild & Adolescent Psychiatry PhysicianME62361FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123073OTHERFLBCBS PROVIDER ID NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558448928
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANJALI ANIL PATHAK MD
Provider Business Mailing Address
First Line : 5251 EMERSON ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-4932
Country : US
Telephone Number : 904-399-0324
Fax Number : 904-399-0420
Provider Business Practice Location Address
First Line : 5251 EMERSON ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-4932
Country : US
Telephone Number : 904-399-0324
Fax Number : 904-399-0420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 04/20/2026

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