Provider Demographics
NPI:1235764580
Name:JAJA, CHEEDY (PHD, MSN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:CHEEDY
Middle Name:
Last Name:JAJA
Suffix:
Gender:M
Credentials:PHD, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 LAKE MURRAY BLVD APT 11303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-0851
Mailing Address - Country:US
Mailing Address - Phone:941-210-2508
Mailing Address - Fax:
Practice Address - Street 1:COLLEGE OF NURSING 1601 GREENE STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29208-0001
Practice Address - Country:US
Practice Address - Phone:803-777-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22293A163W00000X
SC222993163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse