Provider Demographics
NPI:1891160859
Name:AMIT VIJAPURA MD PA
Entity Type:Organization
Organization Name:AMIT VIJAPURA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:VIJAPURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-733-7333
Mailing Address - Street 1:9141 CYPRESS GREEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2013
Mailing Address - Country:US
Mailing Address - Phone:904-733-7333
Mailing Address - Fax:904-404-8342
Practice Address - Street 1:9141 CYPRESS GREEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2013
Practice Address - Country:US
Practice Address - Phone:904-733-7333
Practice Address - Fax:904-404-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59803103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty