Individual
JAYANTHI SIVASOTHY LEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7208
(214) 645-3838
(214) 645-3839
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-3838
(214) 645-3839
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2008-00694
NC
207V00000X
Obstetrics & Gynecology Physician
K9833
TX
207VX0201X
Gynecologic Oncology Physician
2008-00694
NC
207VX0201X
Gynecologic Oncology Physician
Primary
K9833
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165917901
—
TX
01
—
2008-00694
STATE LICENSE
NC
01
—
N94008
SC MEDICAID
SC
Enumeration date
04/25/2006
Last updated
12/29/2010
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