Provider Demographics
NPI:1912967670
Name:MANOHAR, SHONITH (MD)
Entity type:Individual
Prefix:DR
First Name:SHONITH
Middle Name:
Last Name:MANOHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8259 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-737-7246
Mailing Address - Fax:904-737-2700
Practice Address - Street 1:8259 BAYBERRY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7432
Practice Address - Country:US
Practice Address - Phone:904-737-7246
Practice Address - Fax:904-737-2700
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66980207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000819761CMedicaid
FL259304100Medicaid
FL21012YMedicare PIN
FLG44361Medicare UPIN