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General NPI Number Information
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NPI Number | 1760214530
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Entity Type | Organization
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Legal Business Name | EGAO PLLC
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 1550 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4161
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Country | US
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Telephone | 518-466-4294
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 RIVERSIDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4161
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JASMINE SHAKYA
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Credential | DDS
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Telephone | 518-466-4294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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