Shivam Khosla, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

OS24072 Issued in FL

Practice address

2021 Professional Center Dr Ste 101
Orange Park, FL 32073-4461

Phone

(904) 213-9210

NPI assigned

Apr 5, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Interoperability endpoints

• Direct secure messaging: shivam.khosla@hca4.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Memorial Family Practice Associates, LLC

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1598869844
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1356082044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 PROFESSIONAL CENTER DR STE 101",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 PROFESSIONAL CENTER DR STE 101",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734461",
            "telephone_number": "904-213-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOSLA",
        "first_name": "SHIVAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "OS24072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kens United Optical
• Key Medical Transport, LLC.
• Keys to the Heart Healthcare LLC
• Mohammad Harisullah Khan, M.D
• Ubaid Aslam Khokhar, MD
• Lyubov Khvan
• Kick Some Mass, LLC
• Daniel Kiehl, DO
• Rebecca Kiehl
• Caroline Kiely

• Psychiatry Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.