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General NPI Number Information
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NPI Number | 1295870830
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Entity Type | Organization
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Legal Business Name | PAUL D JAYACHANDRA M D P A
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 1680 OSCEOLA ELEMENTARY SCHOOL ROAD SUITE A
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City | ST AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-824-7476
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Fax | 904-824-7870
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Provider Business Mailing Address
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Address Line | 1680 OSCEOLA ELEMENTARY SCHOOL ROAD SUITE A
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City | ST AUGUSTINE
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State | FL
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Zip | 32084
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Country | US
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Telephone | 904-824-7476
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Fax | 904-824-7870
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JENNIFER RAE FAIRCLOTH
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Credential | L P N
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Telephone | 904-824-7476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME0066989
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License Number State | FL
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