| J Mandava Llc | |
|
255 Spencer Rd Suite 201 Saint Peters MO 63376-2494 | |
| (636) 939-2550 | |
| (636) 939-2551 |
| Full Name | J Mandava Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 255 Spencer Rd, Saint Peters, Missouri |
| Authorized Official Name and Position | Jyothi Mandava (OWNER) |
| Authorized Official Contact | 6369392550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Mandava Llc 255 Spencer Rd Suite 201 Saint Peters MO 63376-2494 Ph: (636) 939-2550 | J Mandava Llc 255 Spencer Rd Suite 201 Saint Peters MO 63376-2494 Ph: (636) 939-2550 |
| NPI Number | 1811083892 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 06/18/2008 |
| Medicare PECOS PAC ID | 1355413998 |
|---|---|
| Medicare Enrollment ID | O20080626000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811083892 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jyothi Mandava |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891809539 PECOS PAC ID: 4284631672 Enrollment ID: I20061027000015 |
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