MEDICARE: SASWATA ROY 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	207YP0228X	Pediatric Otolaryngology Physician	ME92036	FL
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	ME92036	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801902739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SASWATA ROY MD

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD
Second Line	:	STE 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-396-4893

Provider Business Practice Location Address
First Line	:	11705 SAN JOSE BLVD
Second Line	:	STE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1835
Country	:	US
Telephone Number	:	904-880-0911
Fax Number	:	904-880-9388

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	11/30/2016

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Directions to “ SASWATA ROY MD” Practice Location

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