Provider Demographics
NPI:1215140454
Name:SHANBHAG, SATISH P (MD,MPH)
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:P
Last Name:SHANBHAG
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:904-363-2606
Practice Address - Street 1:2370 MARKET DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4326
Practice Address - Country:US
Practice Address - Phone:904-264-6201
Practice Address - Fax:904-264-6858
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL2568207R00000X
MDD70907207RH0003X
PAMT191302207RH0003X
FLME143428207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL3890OtherMEDICARE
MD652111800Medicaid
FLNHFDEOtherFLORIDA BLUE
FLP02444215OtherRAILROAD MEDICARE
FL105246400Medicaid