Organization
EGAO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASMINE SHAKYA DDS (DENTIST/OWNER)
(518) 466-4294
Entity
Organization
Contact information
Practice address
1550 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4161
(518) 466-4294
Mailing address
1550 RIVERSIDE AVE, JACKSONVILLE, FL 32204-4161
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0300X
Periodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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