Provider Demographics
NPI:1578517009
Name:SWAMI, SANJAY (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:SWAMI
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 1:9838 OLD BAYMEADOWS RD
Mailing Address - Street 2:PMB # 358
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-642-9001
Mailing Address - Fax:904-642-9150
Practice Address - Street 1:9191 R G SKINNER PARKWAY
Practice Address - Street 2:SUITE 402
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-642-9001
Practice Address - Fax:904-642-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87944207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH67469Medicare UPIN
FL71627YMedicare ID - Type Unspecified