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General NPI Number Information
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NPI Number | 1659329308
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Entity Type | Individual
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Provider Name | MONA JAY SHAH MD
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 11512 LAKE MEAD AVE UNIT 604
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9686
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Country | US
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Telephone | 904-717-3510
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Fax | 904-667-0101
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Provider Business Mailing Address
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Address Line | 11512 LAKE MEAD AVE UNIT 604
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9686
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Country | US
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Telephone | 904-717-3510
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Fax | 904-667-0101
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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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | ME94951
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME94951
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License Number State | FL
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