MEDICARE: SATISH P SHANBHAG MD,MPH

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	207R00000X	Internal Medicine Physician	L2568	AL
2	207RH0003X	Hematology & Oncology Physician	D70907	MD
3	207RH0003X	Hematology & Oncology Physician	MT191302	PA
4	207RH0003X	Hematology & Oncology Physician	ME143428	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L3890	OTHER	FL	MEDICARE
4	P02444215	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	NHFDE	OTHER	FL	FLORIDA BLUE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215140454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATISH P SHANBHAG MD,MPH

Provider Business Mailing Address
First Line	:	7015 A C SKINNER PKWY STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6932
Country	:	US
Telephone Number	:	904-363-2113
Fax Number	:	904-363-2606

Provider Business Practice Location Address
First Line	:	2370 MARKET DR
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-4326
Country	:	US
Telephone Number	:	904-264-6201
Fax Number	:	904-264-6858

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	05/14/2020

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Directions to “ SATISH P SHANBHAG MD,MPH” Practice Location

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