Provider Demographics
NPI:1447645718
Name:BEJTULLAHU, JACQUELINE MEGAN (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MEGAN
Last Name:BEJTULLAHU
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 1:1301 PLANTATION ISLAND DR S STE 404
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3118
Mailing Address - Country:US
Mailing Address - Phone:904-461-1560
Mailing Address - Fax:
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 404
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3118
Practice Address - Country:US
Practice Address - Phone:904-461-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY294469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program