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General NPI Number Information
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NPI Number | 1780746602
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Entity Type | Organization
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Legal Business Name | VR JASTY MD PLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1525 UNIVERSITY DR
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City | AUBURN HILLS
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State | MI
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Zip | 48326-2675
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Country | US
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Telephone | 586-484-7159
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Fax | 248-385-5771
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Provider Business Mailing Address
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Address Line | 6720 BIRMINGHAM CLUB DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-3119
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Country | US
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Telephone | 586-484-7159
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Fax | 248-385-5771
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. VENKATA RAMANA JASTY
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Credential | MD
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Telephone | 586-484-7159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 4301057306
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License Number State | MI
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