Provider Demographics
NPI:1083027122
Name:JAYARAMAN, SHYAM SUNDAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:SUNDAR
Last Name:JAYARAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SHYAM
Other - Middle Name:SUNDAR
Other - Last Name:J
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:194 THOMAS JOHNSON DR STE C
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4683
Mailing Address - Country:US
Mailing Address - Phone:240-575-2526
Mailing Address - Fax:
Practice Address - Street 1:194 THOMAS JOHNSON DR STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4683
Practice Address - Country:US
Practice Address - Phone:240-575-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0083816208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program