Provider Demographics
NPI:1821302266
Name:JOSEPH, JAYA (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:JAYA
Other - Middle Name:
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-467-0880
Mailing Address - Fax:954-525-2030
Practice Address - Street 1:1101 NW 1 STREET
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-8905
Practice Address - Country:US
Practice Address - Phone:954-467-0880
Practice Address - Fax:954-525-2030
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1330133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered