Individual
JASHODEEP DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1475 NW 12TH AVE FL 2, MIAMI, FL 33136-1002
(305) 243-4902
(305) 243-4907
Mailing address
1475 NW 12TH AVE FL 2, MIAMI, FL 33136-1002
(305) 243-4902
(305) 243-4907
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MT197449
PA
2086X0206X
Surgical Oncology Physician
Primary
ME141717
FL
390200000X
Student in an Organized Health Care Education/Training Program
MT197449
PA
Other
Enumeration date
05/14/2010
Last updated
07/24/2019
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