Provider Demographics
NPI:1275616278
Name:RAVIPRASAD, JYOTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:RAVIPRASAD
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 1:213 COLONY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6102
Mailing Address - Country:US
Mailing Address - Phone:407-644-0890
Mailing Address - Fax:
Practice Address - Street 1:2450 MAITLAND CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4140
Practice Address - Country:US
Practice Address - Phone:407-875-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94163207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology