Provider Demographics
NPI:1699880682
Name:MASSEAUX, JOY ANITA (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:ANITA
Last Name:MASSEAUX
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 1:501 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4634
Mailing Address - Country:US
Mailing Address - Phone:727-767-3318
Mailing Address - Fax:
Practice Address - Street 1:501 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4634
Practice Address - Country:US
Practice Address - Phone:727-767-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2259282085R0202X
FLME1638712085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808585500Medicaid
NY02758845Medicaid
LA1450502Medicaid
AZ385431Medicaid
NYP00971869OtherRXR MCR
NY932T51OtherBCBS
PA102217735 0001Medicaid
SCQ25928Medicaid
FL118897200Medicaid
KY7100060780Medicaid
NY932T51OtherBCBS
ID808585500Medicaid
NYA400050812Medicare PIN