Healthcare Provider Details

I. General information

NPI: 1679834725
Provider Name (Legal Business Name): JYOTHI GUNTA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CLEMATIS ST STE 5-531
WEST PALM BEACH FL
33401-5107
US

IV. Provider business mailing address

800 CLEMATIS ST STE 5-531
WEST PALM BEACH FL
33401-5107
US

V. Phone/Fax

Practice location:
  • Phone: 561-671-4036
  • Fax:
Mailing address:
  • Phone: 561-671-4036
  • Fax: 561-837-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME136482
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME136482
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME136482
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME136482
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME136482
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: