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General NPI Number Information
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NPI Number | 1275616278
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Entity Type | Individual
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Provider Name | JYOTHI RAVIPRASAD M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 2450 MAITLAND CENTER PKWY SUITE 100
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City | MAITLAND
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State | FL
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Zip | 32751-4140
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Country | US
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Telephone | 407-875-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 213 COLONY SPRINGS LN
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City | MAITLAND
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State | FL
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Zip | 32751-6102
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Country | US
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Telephone | 407-644-0890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME 94163
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License Number State | FL
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