Provider Demographics
NPI:1780628495
Name:SINHA, JAYASHREE (MD)
Entity Type:Individual
Prefix:
First Name:JAYASHREE
Middle Name:
Last Name:SINHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 21ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4084
Mailing Address - Country:US
Mailing Address - Phone:575-935-5051
Mailing Address - Fax:575-935-5054
Practice Address - Street 1:1600 W 21ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4084
Practice Address - Country:US
Practice Address - Phone:575-935-5051
Practice Address - Fax:575-935-5054
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0328207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55559379Medicaid
NM349732502Medicare PIN
NM55559379Medicaid