Provider Demographics
NPI:1093182370
Name:MURALIDHARAN, JAYSHREE
Entity type:Individual
Prefix:MRS
First Name:JAYSHREE
Middle Name:
Last Name:MURALIDHARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HANTON WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4431
Mailing Address - Country:US
Mailing Address - Phone:440-759-9034
Mailing Address - Fax:
Practice Address - Street 1:341 HANTON WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4431
Practice Address - Country:US
Practice Address - Phone:440-759-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI1801227104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP808414OtherDRIVER'S LICENSE