Provider Demographics
NPI:1356367650
Name:SINHA KHONA, TRACY (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SINHA KHONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 UNIVERSITY BLVD S STE 4A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4322
Mailing Address - Country:US
Mailing Address - Phone:904-733-6487
Mailing Address - Fax:904-733-6542
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 4A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4322
Practice Address - Country:US
Practice Address - Phone:904-733-6487
Practice Address - Fax:904-733-6542
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26358207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259244400Medicaid
FL79398Medicare PIN