Healthcare Provider Details

I. General information

NPI: 1528756756
Provider Name (Legal Business Name): JESSICA SAJI JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E EDGEWOOD DR
LAKELAND FL
33803-3604
US

IV. Provider business mailing address

4500 PARSONS BLVD STE 410
FLUSHING NY
11355-2205
US

V. Phone/Fax

Practice location:
  • Phone: 863-669-1212
  • Fax: 863-666-6089
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME178742
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: