Healthcare Provider Details

I. General information

NPI: 1598133993
Provider Name (Legal Business Name): JS HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N LAKEMONT AVE SUITE 2300
WINTER PARK FL
32792
US

IV. Provider business mailing address

PO BOX 948237
MAITLAND FL
32794-8237
US

V. Phone/Fax

Practice location:
  • Phone: 321-444-6560
  • Fax: 407-960-1902
Mailing address:
  • Phone: 321-444-6560
  • Fax: 407-960-1902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHWETANSHU MAHESHKUMAR SHUKLA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 407-415-9196