Basic Information
| Provider Information | |||||||||
| NPI: | 1144225939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVASHIA | ||||||||
| FirstName: | JAYDEV | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4371 VERONICA S SHOEMAKER BLVD | ||||||||
| Address2: | ATTN: CREDENTIALING DEPT | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339162216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392748200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40107 HIGHWAY 27 STE 200 | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338375901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634219705 | ||||||||
| FaxNumber: | 8634219779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | ME57515 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207R00000X | ME57515 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 063384400 | 05 | FL | MEDICAID | 10719 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |