Healthcare Provider Details

I. General information

NPI: 1861545303
Provider Name (Legal Business Name): JAY WADDADAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 SE SALERNO RD STE 200
STUART FL
34997-6572
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5757
  • Fax: 772-223-5789
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME117635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: