Provider Demographics
NPI:1790104800
Name:SHAMS JAVANI, NAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVID
Middle Name:
Last Name:SHAMS JAVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:NAVID
Other - Middle Name:
Other - Last Name:SHAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE 4015
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6004
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1570 ISLAND LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7453
Practice Address - Country:US
Practice Address - Phone:904-264-1204
Practice Address - Fax:904-264-1727
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA141868207Q00000X
FLME145147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107711400Medicaid