Provider Demographics
NPI:1356544332
Name:JESSANI, NAUSHAD R (MD)
Entity type:Individual
Prefix:DR
First Name:NAUSHAD
Middle Name:R
Last Name:JESSANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N. WAYNE AVE
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087
Mailing Address - Country:US
Mailing Address - Phone:610-975-9435
Mailing Address - Fax:610-975-9851
Practice Address - Street 1:121 N WAYNE AVE
Practice Address - Street 2:SUITE # 300
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3542
Practice Address - Country:US
Practice Address - Phone:610-975-9435
Practice Address - Fax:610-975-9851
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 062610 L2084P0800X
PAMD - 062610 L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry