Provider Demographics
NPI:1386645778
Name:PADMANABHAN, JAYALAKSHMI (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:JAYALAKSHMI
Middle Name:
Last Name:PADMANABHAN
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5685
Mailing Address - Country:US
Mailing Address - Phone:904-264-0000
Mailing Address - Fax:904-264-1828
Practice Address - Street 1:108 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5685
Practice Address - Country:US
Practice Address - Phone:904-264-0000
Practice Address - Fax:904-264-1828
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19491207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6895400OtherBLACK LUNG
FL1504223OtherUNITED MINE WORKER
FLD52033Medicare UPIN
FL10052Medicare ID - Type Unspecified