Provider Demographics
NPI:1841245917
Name:MOHANTY, JYOTI (MD)
Entity Type:Individual
Prefix:
First Name:JYOTI
Middle Name:
Last Name:MOHANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 45TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2450
Mailing Address - Country:US
Mailing Address - Phone:561-882-6060
Mailing Address - Fax:561-882-4622
Practice Address - Street 1:927 45TH ST
Practice Address - Street 2:STE 204
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-882-6060
Practice Address - Fax:561-882-4622
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88542207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
82745ZMedicare ID - Type Unspecified
H24110Medicare UPIN