Healthcare Provider Details

I. General information

NPI: 1417642976
Provider Name (Legal Business Name): SUNLIGHT PSYCHIATRY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16305 CHERRY ORCHARD DR
WILDWOOD MO
63040-1653
US

IV. Provider business mailing address

16305 CHERRY ORCHARD DR
WILDWOOD MO
63040-1653
US

V. Phone/Fax

Practice location:
  • Phone: 504-376-3489
  • Fax: 314-207-9976
Mailing address:
  • Phone: 504-376-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYAPRABHA VIJAYKUMAR NAIR
Title or Position: PSYCHIATRIST/OWNER
Credential: MD, MPH
Phone: 504-376-3489