Healthcare Provider Details

I. General information

NPI: 1265995245
Provider Name (Legal Business Name): JEFFREY Z SHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 PRUDENTIAL DR STE 310
JACKSONVILLE FL
32207-8185
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-8656
  • Fax: 904-390-7488
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME182948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: