Healthcare Provider Details

I. General information

NPI: 1336983683
Provider Name (Legal Business Name): SHAI JEDIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

11 PLAZA REAL S APT 802
BOCA RATON FL
33432-4897
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-4440
  • Fax:
Mailing address:
  • Phone: 310-363-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11047781
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9606190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: