Provider Demographics
NPI:1659762193
Name:REYES BAHAMONDE, JOSELYN (MD)
Entity type:Individual
Prefix:
First Name:JOSELYN
Middle Name:
Last Name:REYES BAHAMONDE
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 1:30 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2669
Mailing Address - Country:US
Mailing Address - Phone:610-252-6950
Mailing Address - Fax:
Practice Address - Street 1:30 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2669
Practice Address - Country:US
Practice Address - Phone:610-252-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292945207RN0300X
390200000X
PAMD474307207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program