Provider Demographics
NPI:1073554846
Name:GANATRA, JAYSHREE V (MD)
Entity Type:Individual
Prefix:
First Name:JAYSHREE
Middle Name:V
Last Name:GANATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13770 PLANTATION RD STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4460
Mailing Address - Country:US
Mailing Address - Phone:239-561-6365
Mailing Address - Fax:239-561-6264
Practice Address - Street 1:13770 PLANTATION RD
Practice Address - Street 2:UNIT 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4460
Practice Address - Country:US
Practice Address - Phone:239-561-6365
Practice Address - Fax:239-561-6264
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2018-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME00825372080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262076600Medicaid
FL262076600Medicaid