Basic Information
| Provider Information | |||||||||
| NPI: | 1083935670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | JHARNA | ||||||||
| MiddleName: | NITIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 PRUDENTIAL DR FL B11 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043886518 | ||||||||
| FaxNumber: | 9043841005 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 PRUDENTIAL DR STE 1100 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043886518 | ||||||||
| FaxNumber: | 9043841005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2010 | ||||||||
| LastUpdateDate: | 10/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | BP10037316 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | ME142041 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084A2900X | ME142041 | FL | Y | 2084N0400X | MD458472 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.