Healthcare Provider Details

I. General information

NPI: 1417865726
Provider Name (Legal Business Name): JAYA SUNIL BHOJWANI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SE SPOKANE ST STE 3000
PORTLAND OR
97202-6487
US

IV. Provider business mailing address

PO BOX 671
DONALD OR
97020-0671
US

V. Phone/Fax

Practice location:
  • Phone: 503-877-0711
  • Fax:
Mailing address:
  • Phone: 503-877-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3812
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: