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General NPI Number Information
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NPI Number | 1538954417
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Entity Type | Organization
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Legal Business Name | JACOB K AGAMASU MD PA
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 756 ELKCAM BLVD STE A
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City | DELTONA
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State | FL
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Zip | 32725-2646
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Country | US
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Telephone | 407-804-9616
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Fax | 407-804-8331
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Provider Business Mailing Address
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Address Line | 731 STIRLING CENTER PL UNIT 1911
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City | LAKE MARY
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State | FL
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Zip | 32746-5209
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Country | US
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Telephone | 407-804-9616
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Fax | 407-804-8331
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Authorized Official
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Title or Position | PRESIDENT
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Name | JACOB K AGAMASU
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Credential | MD
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Telephone | 407-804-9616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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