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NPI Code Detail

MEDICARE: DR. MONA JAY SHAH MD

MEDICARE: DR. MONA JAY SHAH 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
1207UN0901XNuclear Cardiology PhysicianME94951FL
2207RC0000XCardiovascular Disease PhysicianME94951FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01133944OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659329308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MONA JAY SHAH MD
Provider Business Mailing Address
First Line : 11512 LAKE MEAD AVE UNIT 604
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-9686
Country : US
Telephone Number : 904-717-3510
Fax Number : 904-667-0101
Provider Business Practice Location Address
First Line : 11512 LAKE MEAD AVE UNIT 604
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-9686
Country : US
Telephone Number : 904-717-3510
Fax Number : 904-667-0101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/02/2025

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