Healthcare Provider Details

I. General information

NPI: 1649809955
Provider Name (Legal Business Name): JAYSHAL PRAMOD PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 40TH WAY S
LAKE WORTH BEACH FL
33461-5301
US

IV. Provider business mailing address

16385 BISCAYNE BLVD UNIT 519
AVENTURA FL
33160-5457
US

V. Phone/Fax

Practice location:
  • Phone: 888-994-8981
  • Fax:
Mailing address:
  • Phone: 901-493-9904
  • Fax: 929-542-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME163572
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME163572
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME163572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: