MEDICARE: MR. SHAILENDRA JAIN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9485699	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	832251	NV
3	363LF0000X	Family Nurse Practitioner	COA.19140-NP	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174970883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAILENDRA JAIN CNP

Provider Business Mailing Address
First Line	:	4310 METRO PKWY STE 205
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9416
Country	:	US
Telephone Number	:	239-236-8784
Fax Number	:	239-790-2624

Provider Business Practice Location Address
First Line	:	6855 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1675
Country	:	US
Telephone Number	:	725-205-3557
Fax Number	:	866-531-4145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2016
Last Update Date	:	04/29/2025

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