Provider Demographics
NPI:1871512970
Name:SHAKTAWAT, JANMEJAY (MD)
Entity type:Individual
Prefix:DR
First Name:JANMEJAY
Middle Name:
Last Name:SHAKTAWAT
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 1:8562 NE 138TH LN
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8919
Mailing Address - Country:US
Mailing Address - Phone:352-633-8681
Mailing Address - Fax:352-385-7574
Practice Address - Street 1:8562 NE 138TH LN
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8919
Practice Address - Country:US
Practice Address - Phone:352-633-8681
Practice Address - Fax:352-385-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269624000Medicaid
FLU1892YOtherMEDICARE PTAN
FLU1892YOtherMEDICARE PTAN