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NPI Code Detail

MEDICARE: JAYA JOSEPH MS, RD, LD

MEDICARE: JAYA JOSEPH MS, RD, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianND 1330FL

General Provider Information

NPI Number : 1821302266
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYA JOSEPH MS, RD, LD
Provider Business Mailing Address
First Line : 1700 NW 49TH ST STE 125
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33309-3750
Country : US
Telephone Number : 954-467-0880
Fax Number : 954-525-2030
Provider Business Practice Location Address
First Line : 1101 NW 1 STREET
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33311-8905
Country : US
Telephone Number : 954-467-0880
Fax Number : 954-525-2030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2010
Last Update Date : 07/26/2022

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