Provider Demographics
NPI:1194258228
Name:EDEGBE, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:EDEGBE
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 1:2501 HARGILL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1626
Mailing Address - Country:US
Mailing Address - Phone:816-286-0735
Mailing Address - Fax:
Practice Address - Street 1:2350 E MICHIGAN STREET
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-836-9400
Practice Address - Fax:816-404-0003
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME160625207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program