Provider Demographics
NPI:1164426573
Name:NOVAK, JAYSHREE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYSHREE
Middle Name:J
Last Name:NOVAK
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 1:500 N COIT RD
Mailing Address - Street 2:SUITE 2074
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5444
Mailing Address - Country:US
Mailing Address - Phone:972-231-4605
Mailing Address - Fax:972-231-2731
Practice Address - Street 1:500 N COIT RD
Practice Address - Street 2:SUITE 2074
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5444
Practice Address - Country:US
Practice Address - Phone:972-231-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1886208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030321601Medicaid
TX030321601Medicaid