Healthcare Provider Details

I. General information

NPI: 1932692977
Provider Name (Legal Business Name): SAJEEKA JEYAKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 S GRAND BLVD
SAINT LOUIS MO
63104-1027
US

IV. Provider business mailing address

1030 HIGHLANDS PLAZA DR E APT 217
SAINT LOUIS MO
63110-1342
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4828
  • Fax:
Mailing address:
  • Phone: 636-686-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: