Healthcare Provider Details

I. General information

NPI: 1780248740
Provider Name (Legal Business Name): JAYA SUBHA SANAPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL BLVD STE 100
EVANSVILLE IN
47714-8018
US

IV. Provider business mailing address

10477 ASHTON CT
NEWBURGH IN
47630-8891
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax: 812-477-7240
Mailing address:
  • Phone: 812-629-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01088378A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35903
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: