Provider Demographics
NPI:1619064326
Name:SHIN, JAE Y (MD)
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:Y
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3030 N ROCKY POINT DR W
Mailing Address - Street 2:SUITE 670
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5906
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:813-289-6592
Practice Address - Street 1:3030 N ROCKY POINT DR W
Practice Address - Street 2:SUITE 670
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5906
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:813-289-6592
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-03-17
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Provider Licenses
StateLicense IDTaxonomies
FLME94179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME94179OtherSTATE MED.LICENSE
FLG61149Medicare UPIN