Organization
HAMPTON PEDIATRICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATHA SHIVASHANKAR M.D (PRESIDENT)
(904) 998-1448
Entity
Organization
Contact information
Practice address
11512 LAKE MEAD AVE UNIT 201, JACKSONVILLE, FL 32256-9688
(904) 998-1448
(904) 998-1450
Mailing address
11512 LAKE MEAD AVE UNIT 201, JACKSONVILLE, FL 32256-9688
(904) 998-1448
(904) 998-1450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME53102
FL
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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