Provider Demographics
NPI:1669068375
Name:JAISHIVA PA
Entity type:Organization
Organization Name:JAISHIVA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CHOKSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-703-0219
Mailing Address - Street 1:466 SW PORT ST LUCIE BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2091
Mailing Address - Country:US
Mailing Address - Phone:772-918-9034
Mailing Address - Fax:772-918-9022
Practice Address - Street 1:466 SW PORT ST LUCIE BLVD STE 117
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2091
Practice Address - Country:US
Practice Address - Phone:772-918-9034
Practice Address - Fax:772-918-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental