Healthcare Provider Details

I. General information

NPI: 1215516497
Provider Name (Legal Business Name): JESSICA MICHALA JINDRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date: 04/06/2021
Reactivation Date: 05/18/2021

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-1971
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 843-637-9642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101281488
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101281488
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: