Provider Demographics
NPI:1053937763
Name:DAVID, SHISHIR
Entity type:Individual
Prefix:
First Name:SHISHIR
Middle Name:
Last Name:DAVID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 EDGEWOOD AVE W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-2207
Mailing Address - Country:US
Mailing Address - Phone:904-647-3180
Mailing Address - Fax:904-425-9030
Practice Address - Street 1:3059 EDGEWOOD AVE W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2207
Practice Address - Country:US
Practice Address - Phone:904-647-3180
Practice Address - Fax:904-425-9030
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine