MEDICARE: MR. JOSEPH JAMES CANESTRARI PA-C

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
1	363AS0400X	Surgical Physician Assistant	PA9104146	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y04XM	OTHER	FL	FLORIDA BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871700161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH JAMES CANESTRARI PA-C

Provider Business Mailing Address
First Line	:	240 N WICKHAM RD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8663
Country	:	US
Telephone Number	:	321-541-1777
Fax Number	:	321-541-1797

Provider Business Practice Location Address
First Line	:	240 N WICKHAM RD STE 102
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8663
Country	:	US
Telephone Number	:	321-541-1777
Fax Number	:	321-541-1797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	03/31/2025

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