Healthcare Provider Details

I. General information

NPI: 1073702635
Provider Name (Legal Business Name): JAYASHREE SINHA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 21ST ST SUITE B
CLOVIS NM
88101-4084
US

IV. Provider business mailing address

1600 W 21ST ST SUITE B
CLOVIS NM
88101-4084
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-5051
  • Fax: 575-935-5054
Mailing address:
  • Phone: 575-935-5051
  • Fax: 575-935-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2002-0328
License Number StateNM

VIII. Authorized Official

Name: DR. JAYASHREE SINHA
Title or Position: OWNER
Credential: M.D.
Phone: 575-935-5051