Healthcare Provider Details

I. General information

NPI: 1033358262
Provider Name (Legal Business Name): SANDEEP JAIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW 70TH AVE STE 107
PLANTATION FL
33317-2360
US

IV. Provider business mailing address

300 NW 70TH AVE STE 107
PLANTATION FL
33317-2360
US

V. Phone/Fax

Practice location:
  • Phone: 954-530-0848
  • Fax: 954-791-5305
Mailing address:
  • Phone: 954-530-0848
  • Fax: 954-791-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME65687
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDEEP JAIN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 954-530-0848