Provider Demographics
NPI:1336926559
Name:JEANTY, MAX DONALD (MHSC, PA-C)
Entity Type:Individual
Prefix:MR
First Name:MAX
Middle Name:DONALD
Last Name:JEANTY
Suffix:
Gender:M
Credentials:MHSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12401 NE 16TH AVE APT 418
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6014
Mailing Address - Country:US
Mailing Address - Phone:786-316-6879
Mailing Address - Fax:
Practice Address - Street 1:12401 NE 16TH AVE APT 418
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-6014
Practice Address - Country:US
Practice Address - Phone:786-316-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant