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Dr. Van Shantharam, MD
Specialist in Jacksonville, Florida
NPI 1164497186

Van Shantharam is a Specialist based in Jacksonville, FL. Van Shantharam practices in Jacksonville, FL and has the professional credentials of MD. The NPI Number for Van Shantharam is 1164497186 and holds a License No. ME0035945 (Florida).

The current practice location address for Van Shantharam is 2585 Herschel St, Jacksonville, FL and can be reached out via phone at 904-388-2678 and via fax at 904-388-6776.

Location: 2585 Herschel St, Jacksonville, FL, 32204-4557
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1164497186
Provider Name
Van Shantharam
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2585 Herschel St, Jacksonville, FL, 32204-4557
Phone Number
904-388-2678
Fax Number
904-388-6776
Provider Enumeration Date
02/22/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
06999340 05 FL
institution
Provider Business Practice Location Address Details
Address
2585 Herschel St
City
Jacksonville
State
Florida
Zip
32204-4557
Phone Number
904-388-2678
Fax Number
904-388-6776
person
Provider Business Mailing Address Details
Address
2585 Herschel St
City
Jacksonville
State
Florida
Zip
32204-4557
Phone Number
904-388-2678
Fax Number
904-388-6776
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
ME0035945 (Florida)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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