Healthcare Provider Details

I. General information

NPI: 1770530883
Provider Name (Legal Business Name): RAVINDRANAUTH JAMWANT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 WINTER GARDEN VINELAND RD
WINDERMERE FL
34786-6098
US

IV. Provider business mailing address

5151 WINTER GARDEN VINELAND RD
WINDERMERE FL
34786-6098
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-6950
  • Fax: 321-843-6316
Mailing address:
  • Phone: 407-298-6950
  • Fax: 321-843-6316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009818
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: