Provider Demographics
NPI:1386191336
Name:JAYACHANDRAN, PRIYA
Entity Type:Individual
Prefix:MISS
First Name:PRIYA
Middle Name:
Last Name:JAYACHANDRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SYLVAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1432
Mailing Address - Country:US
Mailing Address - Phone:508-873-1254
Mailing Address - Fax:
Practice Address - Street 1:59 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1432
Practice Address - Country:US
Practice Address - Phone:508-873-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32660390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program