Healthcare Provider Details

I. General information

NPI: 1427286939
Provider Name (Legal Business Name): STEPHANIE NICHELLE JADHAV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE NICHELLE GRAHAM MD

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE A510
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE A510
LEXINGTON KY
40504-3751
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-6784
  • Fax: 859-258-6796
Mailing address:
  • Phone: 859-258-6784
  • Fax: 859-258-6796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number46453
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46453
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: