MEDICARE: SHAYAN BENGALI MD

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	207L00000X	Anesthesiology Physician	ME136794	FL

General Provider Information

NPI Number	:	1568880979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYAN BENGALI MD

Provider Business Mailing Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SHIRCLIFF WAY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204
Country	:	US
Telephone Number	:	904-387-4030
Fax Number	:

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

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	01/12/2026

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