Provider Demographics
NPI:1467589549
Name:LANDRY, JAYAN M (APRN)
Entity Type:Individual
Prefix:MS
First Name:JAYAN
Middle Name:M
Last Name:LANDRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JAYAN
Other - Middle Name:LANDRY
Other - Last Name:CONLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:9 BARTLET ST STE 145
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3655
Mailing Address - Country:US
Mailing Address - Phone:978-474-1941
Mailing Address - Fax:
Practice Address - Street 1:21 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3655
Practice Address - Country:US
Practice Address - Phone:978-852-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156486363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0894OtherBCBSMA