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NPI Code Detail

MEDICARE: JERALDINE YESUDHAS

MEDICARE: JERALDINE YESUDHAS
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
1390200000XStudent in an Organized Health Care Education/Training ProgramWV

General Provider Information

NPI Number : 1215709456
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERALDINE YESUDHAS
Provider Business Mailing Address
First Line : 148 KISKADEE DR
Second Line :
City : BUNKER HILL
State : WV
Zip : 25413-8602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 N GEORGE ST STE 200
Second Line :
City : CHARLES TOWN
State : WV
Zip : 25414-1574
Country : US
Telephone Number : 681-252-1632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2023
Last Update Date : 04/13/2026

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Directions to “ JERALDINE YESUDHAS ” Practice Location

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