Provider Demographics
NPI:1588687735
Name:MUNJAL, SANDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:MUNJAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SANDEEP
Other - Middle Name:
Other - Last Name:MUNJAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13241 BARTRAM PARK BLVD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5236
Mailing Address - Country:US
Mailing Address - Phone:904-260-9898
Mailing Address - Fax:904-260-9891
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 301
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5236
Practice Address - Country:US
Practice Address - Phone:904-260-9898
Practice Address - Fax:904-260-9891
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91566207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109726000Medicaid
FL16893YMedicare PIN
I41061Medicare UPIN