Provider Demographics
NPI:1922333467
Name:KOLANDRA, JANSY (MD)
Entity Type:Individual
Prefix:
First Name:JANSY
Middle Name:
Last Name:KOLANDRA
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 1:8328 E. HARTFORD DR.
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-214-9505
Mailing Address - Fax:480-214-9722
Practice Address - Street 1:7975 N HAYDEN RD
Practice Address - Street 2:STE D354
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3243
Practice Address - Country:US
Practice Address - Phone:480-214-9720
Practice Address - Fax:480-214-9722
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70224207R00000X
AZ45264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ634046Medicaid
2151953Medicare PIN