Provider Demographics
NPI:1700026952
Name:SUNDEEPJAYAPRABHU MD LLC
Entity Type:Organization
Organization Name:SUNDEEPJAYAPRABHU MD LLC
Other - Org Name:SUNDEEP JAYAPRABHU MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAYAPRABHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-650-4926
Mailing Address - Street 1:225 S MERAMEC AVE
Mailing Address - Street 2:SUITE #932T
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:314-650-4926
Mailing Address - Fax:
Practice Address - Street 1:225 S MERAMEC AVE
Practice Address - Street 2:SUITE #932T
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-650-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-01
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070270602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty