Healthcare Provider Details

I. General information

NPI: 1508253600
Provider Name (Legal Business Name): SHREYA VINODRAI GHETIYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 UNIVERSITY BLVD S STE 104
JACKSONVILLE FL
32216-2757
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-1171
  • Fax: 904-727-3550
Mailing address:
  • Phone: 904-720-0599
  • Fax: 904-376-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME149855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: