Provider Demographics
NPI:1255719530
Name:BHATTACHARYYA, MAHAMAYA (MD)
Entity type:Individual
Prefix:
First Name:MAHAMAYA
Middle Name:
Last Name:BHATTACHARYYA
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 1:53 AMHERST WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JCT
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1836
Mailing Address - Country:US
Mailing Address - Phone:512-838-4264
Mailing Address - Fax:
Practice Address - Street 1:1717 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3454
Practice Address - Country:US
Practice Address - Phone:646-404-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN701062084P0800X
VA01012682792084P0800X
VA390200000X
MO20200234802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program