Healthcare Provider Details

I. General information

NPI: 1366758187
Provider Name (Legal Business Name): NEHA AGRAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5191 FIRST COAST TECH PKWY FL 2
JACKSONVILLE FL
32224-0609
US

IV. Provider business mailing address

5191 FIRST COAST TECH PKWY FL 2
JACKSONVILLE FL
32224-0609
US

V. Phone/Fax

Practice location:
  • Phone: 904-427-7275
  • Fax:
Mailing address:
  • Phone: 904-427-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME141621
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME141621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: