Provider Demographics
NPI:1144225939
Name:AVASHIA, JAYDEV H (MD)
Entity Type:Individual
Prefix:
First Name:JAYDEV
Middle Name:H
Last Name:AVASHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:40107 HIGHWAY 27 STE 200
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-5901
Practice Address - Country:US
Practice Address - Phone:863-421-9705
Practice Address - Fax:863-421-9779
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57515207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063384400Medicaid
FL10719OtherBLUE CROSS BLUE SHIELD
FL063384400Medicaid
FL10719XMedicare PIN
FL10719OtherBLUE CROSS BLUE SHIELD