Provider Demographics
NPI:1629211305
Name:CHANDAMURI, JESSICA SKOLD CLARK (MD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SKOLD CLARK
Last Name:CHANDAMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:SKOLD
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5640 READ BLVD STE 810
Mailing Address - Street 2:NEW ORLEANS EAST BEHAVIORAL HEALTH CLINIC
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3125
Mailing Address - Country:US
Mailing Address - Phone:504-243-7600
Mailing Address - Fax:504-243-7610
Practice Address - Street 1:5640 READ BLVD STE 810
Practice Address - Street 2:NEW ORLEANS EAST BEHAVIORAL HEALTH CLINIC
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3125
Practice Address - Country:US
Practice Address - Phone:504-243-7600
Practice Address - Fax:504-243-7610
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2053012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1883255Medicaid