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General NPI Number Information
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NPI Number | 1912380221
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Entity Type | Individual
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Provider Name | PRAKASH JAYANTHI MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 3131 E CLARENDON AVE STE 102
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City | PHOENIX
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State | AZ
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Zip | 85016-7069
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Country | US
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Telephone | 602-253-9168
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Fax | 602-251-3126
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Provider Business Mailing Address
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Address Line | 3131 E CLARENDON AVE STE 102
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City | PHOENIX
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State | AZ
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Zip | 85016-7069
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Country | US
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Telephone | 602-253-9168
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Fax | 602-251-3126
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01086267A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301108382
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 77631
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License Number State | AZ
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