Provider Demographics
NPI:1255713954
Name:JAGADESAN, BHUVANESHWARI (MD)
Entity type:Individual
Prefix:DR
First Name:BHUVANESHWARI
Middle Name:
Last Name:JAGADESAN
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 1:853 JEFFERSON AVE SUITE E-201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2227
Mailing Address - Country:US
Mailing Address - Phone:901-448-4750
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVENUE #201 SUITE E-201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2227
Practice Address - Country:US
Practice Address - Phone:901-448-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBE2080N0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA