Healthcare Provider Details

I. General information

NPI: 1619945359
Provider Name (Legal Business Name): SANDEEP JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
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: 964-530-0848
  • Fax: 954-791-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: