MEDICARE: CANADAY AND JAGEDO PHYSICIAN ASSOCIATES PL

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	208600000X	Surgery Physician	ME102632	FL

General Provider Information

NPI Number	:	1780814988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANADAY AND JAGEDO PHYSICIAN ASSOCIATES PL

Provider Business Mailing Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 6
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-325-1157
Fax Number	:	386-325-1161

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 6
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-325-1157
Fax Number	:	386-325-1161

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEROME CANADAY
Credential	:	MD
Telephone Number	:	386-325-1157

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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Practice Location Address:

700 ZEAGLER DR , SUITE 2
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1013987635 — HAROLD HAYES SULLIVAN JR. MD, MPH
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1255308284 — JOHN GRAHAM CHARLES PA
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1902835804 — OMNI HOME HEALTH- HERNANDO, LLC
Practice Location Address:

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Practice Location Address:

700 ZEAGLER DR. , SUITE 9
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1811136633 — KATE MARIE GILRAIN PT, DPT
Practice Location Address:

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Practice Fax:

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