Provider Demographics
NPI:1982639498
Name:SUPPIAH, JAYANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:
Last Name:SUPPIAH
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 1:6565 E GREENWAY PKWY
Mailing Address - Street 2:PARKWAY MEDICAL GROUP
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2056
Mailing Address - Country:US
Mailing Address - Phone:602-726-8805
Mailing Address - Fax:602-944-4147
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 118
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2387
Practice Address - Country:US
Practice Address - Phone:623-825-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33398207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism