Provider Demographics
NPI:1255625513
Name:JASSAL, NAVDEEP SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:NAVDEEP
Middle Name:SINGH
Last Name:JASSAL
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 1:1417 LAKELAND HILLS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3208
Mailing Address - Country:US
Mailing Address - Phone:833-513-7246
Mailing Address - Fax:863-333-4007
Practice Address - Street 1:1417 LAKELAND HILLS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805
Practice Address - Country:US
Practice Address - Phone:833-513-7246
Practice Address - Fax:863-333-4007
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2731862081P2900X
FLME 1222372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL150HROtherBCBS
FLP01510619OtherRR MCR
FL015208900Medicaid
FLIE863ZMedicare PIN