Healthcare Provider Details

I. General information

NPI: 1346774437
Provider Name (Legal Business Name): JAY SHANKAR PRASAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 05/30/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10904 PANTHER CT
HOUSTON TX
77099-5615
US

IV. Provider business mailing address

10904 PANTHER CT
HOUSTON TX
77099-5615
US

V. Phone/Fax

Practice location:
  • Phone: 832-571-4338
  • Fax:
Mailing address:
  • Phone: 832-571-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: