Healthcare Provider Details

I. General information

NPI: 1740418821
Provider Name (Legal Business Name): JAY ASHOK VACHHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7550
  • Fax: 321-841-8185
Mailing address:
  • Phone: 321-841-7550
  • Fax: 321-841-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number125.056613
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME130180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: