Healthcare Provider Details

I. General information

NPI: 1659762193
Provider Name (Legal Business Name): JOSELYN REYES BAHAMONDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 COMMUNITY DR
EASTON PA
18045-2669
US

IV. Provider business mailing address

30 COMMUNITY DR
EASTON PA
18045-2669
US

V. Phone/Fax

Practice location:
  • Phone: 610-252-6950
  • Fax:
Mailing address:
  • Phone: 610-252-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number292945
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD474307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: