Healthcare Provider Details

I. General information

NPI: 1548418288
Provider Name (Legal Business Name): SANJAY MADHUKER JASWANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2008
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14317 CYPRESS ROSEHILL RD
CYPRESS TX
77429-7801
US

IV. Provider business mailing address

PO BOX 392929
PITTSBURGH PA
15251-9900
US

V. Phone/Fax

Practice location:
  • Phone: 713-461-2915
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116020112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: