Healthcare Provider Details

I. General information

NPI: 1639442148
Provider Name (Legal Business Name): JAYAKRISHNA LOYA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 BARD AVE
STATEN ISLAND NY
10310-1664
US

IV. Provider business mailing address

PO BOX 3449
MCALLEN TX
78502-3449
US

V. Phone/Fax

Practice location:
  • Phone: 718-818-1234
  • Fax:
Mailing address:
  • Phone: 956-661-0529
  • Fax: 956-661-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number089542
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number980042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: