Healthcare Provider Details

I. General information

NPI: 1205028149
Provider Name (Legal Business Name): JONATHAN A. BEATTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

IV. Provider business mailing address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

V. Phone/Fax

Practice location:
  • Phone: 772-300-9077
  • Fax: 215-764-6447
Mailing address:
  • Phone: 772-300-9077
  • Fax: 215-764-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD441308
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD441308
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME162732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: