Healthcare Provider Details

I. General information

NPI: 1851852420
Provider Name (Legal Business Name): JAIS MEERA EMMANUEL VALLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 US HIGHWAY 27 N STE 201
SEBRING FL
33870-8226
US

IV. Provider business mailing address

6325 US HIGHWAY 27 N STE 201
SEBRING FL
33870-8226
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-9600
  • Fax:
Mailing address:
  • Phone: 863-382-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168446
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD210002068
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: