Provider Demographics
NPI:1346266970
Name:RAYCHAUDHURI, JYOTISHANKAR (MD, MBBS)
Entity Type:Individual
Prefix:
First Name:JYOTISHANKAR
Middle Name:
Last Name:RAYCHAUDHURI
Suffix:
Gender:M
Credentials:MD, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:801 N FLAMINGO RD STE 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:954-265-4325
Practice Address - Fax:954-443-4747
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74327207R00000X, 207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56279OtherBLUE CROSS BLUE SHIELD
FL276000200Medicaid
FLU8072ZMedicare PIN