Healthcare Provider Details

I. General information

NPI: 1356862775
Provider Name (Legal Business Name): SINDUJA JAYARAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HIGHLAND PARK DR
RICHMOND KY
40475-3839
US

IV. Provider business mailing address

401 HIGHLAND PARK DR
RICHMOND KY
40475-3839
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-7700
  • Fax: 859-626-7890
Mailing address:
  • Phone: 859-626-7700
  • Fax: 859-626-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54491
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: