Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.087978 | OH |
N | 207YP0228X | Pediatric Otolaryngology | 35.087978 | OH |
NPI | 1548362486 |
---|---|
Provider Name | Dr. Anita Jeyakumar |
First Address | Boardman, OH 44512-6778 |
Second Address | Boardman, OH 44512-6778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 20/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2678115 | (05) | OH |
I57909 | (02) |