Provider Demographics
NPI:1821163635
Name:SHAKUNTALA JANWADKAR, MD, PA
Entity Type:Organization
Organization Name:SHAKUNTALA JANWADKAR, MD, PA
Other - Org Name:JAN CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKUNTALA
Authorized Official - Middle Name:SANDEEP
Authorized Official - Last Name:JANWADKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-328-7008
Mailing Address - Street 1:185 WAYMONT CT
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6700
Mailing Address - Country:US
Mailing Address - Phone:407-328-7008
Mailing Address - Fax:407-328-7524
Practice Address - Street 1:185 WAYMONT CT
Practice Address - Street 2:SUITE 111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6700
Practice Address - Country:US
Practice Address - Phone:407-328-7008
Practice Address - Fax:407-328-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086339208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G55455Medicare UPIN