Individual
LATHA SHIVASHANKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11512 LAKE MEAD AVE, SUITE 201, JACKSONVILLE, FL 32256-9680
(904) 998-1448
(904) 998-1450
Mailing address
11512 LAKE MEAD AVE, SUITE 201, JACKSONVILLE, FL 32256
(904) 998-1448
(904) 998-1450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME53102
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058765600
—
FL
Enumeration date
05/09/2006
Last updated
11/29/2012
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