Individual
RAJ D SHETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
807 CHILDREN'S WAY, JACKSONVILLE, FL 32207
(904) 390-3600
(904) 390-3422
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
39298
WI
2084N0400X
Neurology Physician
ME102097
FL
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME102097
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32380900
—
WI
Enumeration date
02/10/2006
Last updated
10/07/2011
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