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General NPI Number Information
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NPI Number | 1477571883
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Entity Type | Individual
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Provider Name | JYOTSNA S PRASAD MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 2428 BAHAMA DR
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City | DALLAS
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State | TX
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Zip | 75211-2121
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Country | US
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Telephone | 972-900-0747
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Fax |
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Provider Business Mailing Address
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Address Line | 820 S MACARTHUR BLVD STE 105-392
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City | COPPELL
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State | TX
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Zip | 75019-4216
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Country | US
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Telephone | 972-900-0747
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Fax | 972-393-5234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L5100
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License Number State | TX
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