Provider Demographics
NPI:1487897500
Name:VISAYA, JIOVANI MIRANDA (MD)
Entity type:Individual
Prefix:DR
First Name:JIOVANI
Middle Name:MIRANDA
Last Name:VISAYA
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 1:15280 NW 79TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:055-583-7243
Mailing Address - Fax:786-907-4485
Practice Address - Street 1:10150 HAGEN RANCH ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-736-8141
Practice Address - Fax:561-736-5662
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258899207Y00000X
MDD77377207Y00000X
FLME123156207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015151100Medicaid