Provider Demographics
NPI:1215072301
Name:NANDAGOPAL, JAYASREE JAYADEVAN (MD)
Entity type:Individual
Prefix:
First Name:JAYASREE
Middle Name:JAYADEVAN
Last Name:NANDAGOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 WINDING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1451
Mailing Address - Country:US
Mailing Address - Phone:513-868-1562
Mailing Address - Fax:
Practice Address - Street 1:7760 UNIVERSITY CT
Practice Address - Street 2:SUITE H
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3371
Practice Address - Country:US
Practice Address - Phone:513-547-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0882162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1215072301OtherALLIANCE SELECT
OH1215072301OtherMEDICAL MUTUAL
OH1215072301OtherUNITED BEHAVIORAL HEALTH (UBH)
OH272314123OtherLIFESYNCH - HUMANA
OH1215072301OtherBEECH STREET
OH1215072301OtherCONCERN - TRI HEALTH
OH2726054Medicaid
OH000000663376OtherANTHEM
OH1215072301OtherAETNA
OH1215072301OtherCIGNA
OH1215072301OtherTRI STATE BENEFITS
OH1215072301OtherHEALTH SPAN
OH1215072301OtherHEALTH SPAN
OHNA4222181Medicare PIN