Provider Demographics
NPI:1457598088
Name:JAYANTI, RAVI K (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:JAYANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 NEBRASKA AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-465-4499
Mailing Address - Fax:
Practice Address - Street 1:1900 NEBRASKA AVE STE 9
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13102207R00000X
NY268411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine