Provider Demographics
NPI:1528201118
Name:JEYAMOHAN, SHIVEINDRA B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVEINDRA
Middle Name:B
Last Name:JEYAMOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1680 ROUTE 23 STE 250
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7520
Mailing Address - Country:US
Mailing Address - Phone:973-633-1122
Mailing Address - Fax:973-832-7550
Practice Address - Street 1:1680 ROUTE 23 STE 250
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7520
Practice Address - Country:US
Practice Address - Phone:973-633-1122
Practice Address - Fax:973-832-7550
Is Sole Proprietor?:No
Enumeration Date:2009-04-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60544491207T00000X
NJ25MA10821200207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery