Healthcare Provider Details

I. General information

NPI: 1518111731
Provider Name (Legal Business Name): ANASTASIA A. S. JANDES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANASTASIA S KRYGIEL MD

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 CREATIVE DR STE 100 #54448
LEXINGTON KY
40505
US

IV. Provider business mailing address

PO BOX 54448
LEXINGTON KY
40555-4448
US

V. Phone/Fax

Practice location:
  • Phone: 606-618-0125
  • Fax: 606-619-4209
Mailing address:
  • Phone: 606-618-0125
  • Fax: 606-619-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46380
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number46380
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: