Provider Demographics
NPI:1528053907
Name:RAVI, JAYANTHI M (MD)
Entity type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:M
Last Name:RAVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 WOODBREEZE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8824
Mailing Address - Country:US
Mailing Address - Phone:407-876-1368
Mailing Address - Fax:
Practice Address - Street 1:9111 WOODBREEZE BLVD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8824
Practice Address - Country:US
Practice Address - Phone:407-876-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048846207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07645OtherBCBS
FL372347000Medicaid
FL372347000Medicaid
E21388Medicare UPIN