Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 036061143 | IL |
NPI | 1144280769 |
---|---|
Provider Name | Jayshree Vajaria |
First Address | Chicago, IL 60674-0018 |
Second Address | Glen Ellyn, IL 60137-4464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 27/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036061143 | (05) | IL |