Provider Demographics
NPI:1881957090
Name:JASTY, SUNEETHA (MD,)
Entity type:Individual
Prefix:DR
First Name:SUNEETHA
Middle Name:
Last Name:JASTY
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 1:120 VALLEY GREEN LN STE 510
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2080
Mailing Address - Country:US
Mailing Address - Phone:484-324-7100
Mailing Address - Fax:
Practice Address - Street 1:120 VALLEY GREEN LN STE 510
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2080
Practice Address - Country:US
Practice Address - Phone:484-324-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10970900207RR0500X
TXR8384207RR0500X
PAMD479378207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology