Provider Demographics
NPI:1083053722
Name:JEYABALAN, ANUSHYA (MD)
Entity Type:Individual
Prefix:
First Name:ANUSHYA
Middle Name:
Last Name:JEYABALAN
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 1:101 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4724
Mailing Address - Country:US
Mailing Address - Phone:617-726-0738
Mailing Address - Fax:
Practice Address - Street 1:101 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4724
Practice Address - Country:US
Practice Address - Phone:617-726-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281036207RN0300X
MA256824207R00000X
NY293682207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine