Individual
DR. JESSE SHANE PELLETIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 NE MIAMI GARDENS DR, SUITE 203, NORTH MIAMI BEACH, FL 33179-4845
(305) 940-1500
(305) 940-1501
Mailing address
1400 NE MIAMI GARDENS DR STE 203, NORTH MIAMI BEACH, FL 33179-4844
(305) 940-1500
(305) 940-1501
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
1898
VI
207W00000X
Ophthalmology Physician
Primary
ME99313
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279056400
—
FL
Enumeration date
02/05/2007
Last updated
04/27/2026
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