Healthcare Provider Details

I. General information

NPI: 1710669783
Provider Name (Legal Business Name): SHARATHI CHIRANGA SIRIMANNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LANE AVE S
JACKSONVILLE FL
32205-4785
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-783-9680
  • Fax: 904-390-7464
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME181475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: