Provider Demographics
NPI:1508157983
Name:LI, JIANYU (MD)
Entity Type:Individual
Prefix:DR
First Name:JIANYU
Middle Name:
Last Name:LI
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 1:499 E CENTRAL PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3450
Mailing Address - Country:US
Mailing Address - Phone:407-960-6709
Mailing Address - Fax:407-960-7627
Practice Address - Street 1:499 E CENTRAL PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3450
Practice Address - Country:US
Practice Address - Phone:407-960-6709
Practice Address - Fax:407-960-6727
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133391207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL2532617OtherDEA
OH3142101Medicaid