Individual
DR. RAJESH KUMAR SHETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11512 LAKE MEAD AVENUE, STE 534, JACKSONVILLE, FL 32256-5835
(904) 642-2222
(904) 518-3297
Mailing address
11945 SAN JOSE BLVD., STE 300, JACKSONVILLE, FL 32223-1627
(904) 396-1725
(904) 399-1717
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME84552
FL
207WX0009X
Glaucoma Specialist (Ophthalmology) Physician
ME84552
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264845800
—
FL
01
—
28020
BLUECROSS/BLUESHIELD
FL
01
—
P01378393
RAILROAD MEDICARE
FL
Enumeration date
10/22/2005
Last updated
04/19/2018
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