Provider Demographics
NPI:1417953076
Name:JAYACHANDRA, PAUL DAVID (M D P A)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:JAYACHANDRA
Suffix:
Gender:M
Credentials:M D P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 OSCEOLA ELEMENTARY RD
Mailing Address - Street 2:STE A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0968
Mailing Address - Country:US
Mailing Address - Phone:904-824-7476
Mailing Address - Fax:904-824-7870
Practice Address - Street 1:1680 OSCEOLA ELEMENTARY RD
Practice Address - Street 2:STE A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-0968
Practice Address - Country:US
Practice Address - Phone:904-824-7476
Practice Address - Fax:904-824-7870
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066989207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAA919OtherMEDICARE PTAN
FL5777008OtherAETNA
FL376531801Medicaid
FL26220OtherBCBS FLORIDA
FL150095OtherHEALTHEASE
FL26220YOtherMEDICARE
FL206068OtherAVMED
FL376531800Medicaid
FL390006717Medicare ID - Type UnspecifiedMEDICARE RAILROAD
FL26220YOtherMEDICARE
FL5777008OtherAETNA