| NPI | 1750115804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAILENDRA KUMAR JAIN Provider 725-205-3557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-08-30 |
| Last Update Date | 2025-01-03 |