MEDICARE: MEDICAL SPECIALISTS OF NORTHEAST FLORIDA PLLC

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

General Provider Information

NPI Number	:	1285938936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SPECIALISTS OF NORTHEAST FLORIDA PLLC

Provider Business Mailing Address
First Line	:	6428 BEACH BLVD STE 1A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2813
Country	:	US
Telephone Number	:	904-475-2039
Fax Number	:	904-330-0668

Provider Business Practice Location Address
First Line	:	6428 BEACH BLVD STE 1A
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2813
Country	:	US
Telephone Number	:	904-342-0816
Fax Number	:	904-342-0553

Authorized Official
Title or Position	:	MEMBER
Name	:	MADHU SHARAM
Credential	:
Telephone Number	:	904-718-3184

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	09/15/2025

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