J Mandava LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

J MANDAVA LLC

Practice address

255 Spencer Rd
Suite 201
Saint Peters, MO 63376-2494

Phone

(636) 939-2550

Fax

(636) 939-2551

NPI assigned

Oct 5, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jyothi Mandava, MDNPI 1891809539

Title

Owner

Phone

(636) 939-2550

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jyothi Mandava, M.D.

  • Psychiatry Physician
  • Chesterfield, MO
  • NPI 1891809539
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1811083892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 SPENCER RD",
            "address_2": "SUITE 201",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633762494",
            "telephone_number": "636-939-2550",
            "fax_number": "636-939-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 SPENCER RD",
            "address_2": "SUITE 201",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633762494",
            "telephone_number": "636-939-2550",
            "fax_number": "636-939-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J MANDAVA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "MANDAVA",
        "authorized_official_first_name": "JYOTHI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "636-939-2550",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.