Healthcare Provider Details

I. General information

NPI: 1437092889
Provider Name (Legal Business Name): SWATI SHAH, MD RHEUMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9765 SAN JOSE BLVD STE 103
JACKSONVILLE FL
32257-5467
US

IV. Provider business mailing address

9765 SAN JOSE BLVD STE 103
JACKSONVILLE FL
32257-5467
US

V. Phone/Fax

Practice location:
  • Phone: 904-517-8222
  • Fax: 904-517-1222
Mailing address:
  • Phone: 904-517-8222
  • Fax: 904-517-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: SWATI SHAH
Title or Position: OWNER
Credential: MD
Phone: 904-517-8222