Provider Demographics
NPI:1144751074
Name:JOY, JESTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JESTIN
Middle Name:
Last Name:JOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JESTIN
Other - Middle Name:JOY
Other - Last Name:PUDUSSERY KATTALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:6010 REESE RD APT 207
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1221
Mailing Address - Country:US
Mailing Address - Phone:954-496-6290
Mailing Address - Fax:
Practice Address - Street 1:1309 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3406
Practice Address - Country:US
Practice Address - Phone:561-655-5511
Practice Address - Fax:762-212-4492
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME144042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine