Provider Demographics
NPI:1427049105
Name:JEANTY, JEAN-CLAUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-CLAUDE
Middle Name:
Last Name:JEANTY
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 1:1275 W GRANADA BLVD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8259
Mailing Address - Country:US
Mailing Address - Phone:386-672-1490
Mailing Address - Fax:386-672-1682
Practice Address - Street 1:1275 W GRANADA BLVD
Practice Address - Street 2:SUITE 3A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8259
Practice Address - Country:US
Practice Address - Phone:386-672-1490
Practice Address - Fax:386-672-1682
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14019OtherFLORIDA HOSPITAL HEALTH
FL761792OtherFIRST HEALTH
FL2672715900Medicaid
FL759373OtherCONNECTICARE
FL1202000OtherUNITED HEALTH CARE MEDICA
FL6633914-001OtherCIGNA
FL5907098OtherAETNA
FL26333OtherBLUE CROSS
FL26334Medicare ID - Type UnspecifiedMEDICARE
FL1202000OtherUNITED HEALTH CARE MEDICA