Provider Demographics
NPI:1902154859
Name:KOLLAMPARE, SHUBHA (MD)
Entity Type:Individual
Prefix:
First Name:SHUBHA
Middle Name:
Last Name:KOLLAMPARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5130
Mailing Address - Country:US
Mailing Address - Phone:904-276-0001
Mailing Address - Fax:904-276-5333
Practice Address - Street 1:2100 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5130
Practice Address - Country:US
Practice Address - Phone:904-276-0001
Practice Address - Fax:904-276-5333
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME153239207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty