Healthcare Provider Details

I. General information

NPI: 1609393594
Provider Name (Legal Business Name): ACE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STATE ROAD 207 STE 101B
ST AUGUSTINE FL
32084-5939
US

IV. Provider business mailing address

6428 BEACH BLVD
JACKSONVILLE FL
32216-2813
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-0816
  • Fax: 904-342-0553
Mailing address:
  • Phone: 904-475-2039
  • Fax: 904-330-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADHUKAR SHARMA
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 904-718-3184