Healthcare Provider Details

I. General information

NPI: 1417188624
Provider Name (Legal Business Name): JYOTHI A AMIN D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST STE 209
NORTH ANDOVER MA
01845-5070
US

IV. Provider business mailing address

451 ANDOVER ST STE 209
NORTH ANDOVER MA
01845-5070
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-7623
  • Fax: 978-683-9911
Mailing address:
  • Phone: 978-686-7623
  • Fax: 978-683-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3611
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD-2525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: