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General NPI Number Information
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NPI Number | 1881957090
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Entity Type | Individual
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Provider Name | SUNEETHA JASTY M.D.,
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 2360 MARYLAND RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1709
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Country | US
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Telephone | 215-657-6776
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Fax | 267-913-5961
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Provider Business Mailing Address
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Address Line | 120 VALLEY GREEN LN STE 510
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2080
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Country | US
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Telephone | 484-324-7100
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Fax |
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 25MA10970900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD479378
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | R8384
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License Number State | TX
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