Healthcare Provider Details

I. General information

NPI: 1144225939
Provider Name (Legal Business Name): JAYDEV H AVASHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40107 HIGHWAY 27 STE 200
DAVENPORT FL
33837-5901
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIALING DEPT
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 863-421-9705
  • Fax: 863-421-9779
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME57515
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME57515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: