Provider Demographics
NPI:1356520720
Name:SINGH, JYOTI J (PA-C)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:J
Last Name:SINGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 E 86TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-6860
Mailing Address - Country:US
Mailing Address - Phone:317-975-3441
Mailing Address - Fax:
Practice Address - Street 1:675 E HICKORY LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8512
Practice Address - Country:US
Practice Address - Phone:317-883-7712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000696A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00437636OtherRAILROAD MEDICARE
IN000000546943OtherANTHEM PIN NUMBER
INP00437636OtherRAILROAD MEDICARE
IN151560022Medicare PIN
INP00437636OtherRAILROAD MEDICARE
IN069350QMedicare PIN