Provider Demographics
NPI:1659329308
Name:SHAH, MONA JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:JAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0799
Mailing Address - Fax:904-241-5942
Practice Address - Street 1:1361 13TH AVE S STE 270
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3258
Practice Address - Country:US
Practice Address - Phone:904-241-7147
Practice Address - Fax:904-241-5942
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME94951207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275142900Medicaid
FLP01133944OtherRAILROAD MEDICARE
FL275142900Medicaid