Provider Demographics
NPI:1962140236
Name:CHAJULALL, JAWAHARLALL JEFF (APRN)
Entity type:Individual
Prefix:
First Name:JAWAHARLALL
Middle Name:JEFF
Last Name:CHAJULALL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 WINIFRED AVE
Mailing Address - Street 2:
Mailing Address - City:ZELLWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32798-0908
Mailing Address - Country:US
Mailing Address - Phone:407-446-4002
Mailing Address - Fax:
Practice Address - Street 1:9832 US HIGHWAY 441 STE 101
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3984
Practice Address - Country:US
Practice Address - Phone:352-787-3341
Practice Address - Fax:352-787-7491
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026839363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120808200Medicaid