MEDICARE: MR. SYAMJITH JAYADEVAN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP144478	TX
2	363LF0000X	Family Nurse Practitioner	AP144478	TX
3	363LF0000X	Family Nurse Practitioner	95020417	CA
4	363LF0000X	Family Nurse Practitioner	C-APN.0002957-C-NP	CO

General Provider Information

NPI Number	:	1033758578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SYAMJITH JAYADEVAN NP

Provider Business Mailing Address
First Line	:	10743 NOVY GROVE DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-5568
Country	:	US
Telephone Number	:	832-800-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	11658 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-3612
Country	:	US
Telephone Number	:	832-800-6044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	04/21/2026

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