Provider Demographics
NPI:1366504342
Name:SHETTY, DAYANANDA MULUR (MD)
Entity Type:Individual
Prefix:
First Name:DAYANANDA
Middle Name:MULUR
Last Name:SHETTY
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 1:9831 DEL WEBB PARKWAY
Mailing Address - Street 2:#2305
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-5807
Mailing Address - Country:US
Mailing Address - Phone:904-519-6575
Mailing Address - Fax:904-519-6575
Practice Address - Street 1:9831 DEL WEBB PARKWAY
Practice Address - Street 2:#2305
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5807
Practice Address - Country:US
Practice Address - Phone:904-519-6575
Practice Address - Fax:904-519-6575
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026607A207Y00000X
FLME86870207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN91107713OtherBCBS
IN100141560AMedicaid
49504600121OtherAMA
IN100141560AMedicaid
49504600121OtherAMA