Provider Demographics
NPI:1548266182
Name:YAJNIK, CHAITANYA H (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:H
Last Name:YAJNIK
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:P.O. BOX 9671
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9671
Mailing Address - Country:US
Mailing Address - Phone:386-676-7130
Mailing Address - Fax:386-676-7125
Practice Address - Street 1:309 PALM COAST PARKWAY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3886
Practice Address - Country:US
Practice Address - Phone:386-676-7130
Practice Address - Fax:386-676-7125
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19984207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64199847Medicaid
WV0082984000Medicaid
WV0082984000Medicaid
KY1457101Medicare ID - Type Unspecified