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NPI Code Detail

MEDICARE: AMRITA GAVRIELLE GUNDAVDA PA-S

MEDICARE: AMRITA GAVRIELLE GUNDAVDA PA-S
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1699614545
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMRITA GAVRIELLE GUNDAVDA PA-S
Provider Business Mailing Address
First Line : 1050 HENDRICKS AVE UNIT 104
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8360
Country : US
Telephone Number : 571-287-0190
Fax Number :
Provider Business Practice Location Address
First Line : 6675 CORPORATE CENTER PKWY STE 115
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-8088
Country : US
Telephone Number : 904-245-8910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2026
Last Update Date : 03/26/2026

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Directions to “ AMRITA GAVRIELLE GUNDAVDA PA-S” Practice Location

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