Provider Demographics
NPI:1699285684
Name:JEAN, SWETHA SUNDARALINGAM (PA-C)
Entity type:Individual
Prefix:
First Name:SWETHA
Middle Name:SUNDARALINGAM
Last Name:JEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SWETHA
Other - Middle Name:LEANA
Other - Last Name:SUNDARALINGAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8990 R G SKINNER PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4020
Mailing Address - Country:US
Mailing Address - Phone:904-519-6555
Mailing Address - Fax:904-519-6550
Practice Address - Street 1:8990 R G SKINNER PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4020
Practice Address - Country:US
Practice Address - Phone:904-519-6555
Practice Address - Fax:904-519-6550
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111027363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant