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General NPI Number Information
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NPI Number | 1255625513
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Entity Type | Individual
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Provider Name | NAVDEEP SINGH JASSAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 1417 LAKELAND HILLS BLVD STE 201
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City | LAKELAND
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State | FL
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Zip | 33805
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Country | US
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Telephone | 833-513-7246
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Fax | 863-333-4007
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Provider Business Mailing Address
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Address Line | 1417 LAKELAND HILLS BLVD STE 201
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City | LAKELAND
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State | FL
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Zip | 33805-3208
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Country | US
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Telephone | 833-513-7246
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Fax | 863-333-4007
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 273186
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | ME 122237
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License Number State | FL
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