Provider Demographics
NPI:1518111731
Name:JANDES, ANASTASIA A S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANASTASIA
Middle Name:A S
Last Name:JANDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANASTASIA
Other - Middle Name:S
Other - Last Name:KRYGIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 54448
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40555-4448
Mailing Address - Country:US
Mailing Address - Phone:606-618-0125
Mailing Address - Fax:606-619-4209
Practice Address - Street 1:2041 CREATIVE DR STE 100 #54448
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505
Practice Address - Country:US
Practice Address - Phone:606-618-0125
Practice Address - Fax:606-619-4209
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46380207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100375100Medicaid