Provider Demographics
NPI:1609841303
Name:NAYAK, TEJASWINI R (MD)
Entity type:Individual
Prefix:
First Name:TEJASWINI
Middle Name:R
Last Name:NAYAK
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 1:1820 ZUMBEHL RD
Mailing Address - Street 2:SUITE 120-A
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-2761
Mailing Address - Country:US
Mailing Address - Phone:636-928-1237
Mailing Address - Fax:636-928-0397
Practice Address - Street 1:1820 ZUMBEHL RD
Practice Address - Street 2:SUITE 120-A
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2761
Practice Address - Country:US
Practice Address - Phone:636-928-1237
Practice Address - Fax:636-928-0397
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002015974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO907095280Medicare PIN
H95161Medicare UPIN