MEDICARE: JANNY MESA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD477972	PA
2	2084P0800X	Psychiatry Physician	A177864	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2084P0800X	Psychiatry Physician	ME152246	FL

General Provider Information

NPI Number	:	1902469323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNY MESA MD

Provider Business Mailing Address
First Line	:	936 SW 1ST AVE # 162
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 SW 1ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-4520
Country	:	US
Telephone Number	:	305-252-5899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	07/02/2025

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