Provider Demographics
NPI:1225067408
Name:DR. SHIRANEE JAYASOORIYA INC
Entity Type:Organization
Organization Name:DR. SHIRANEE JAYASOORIYA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHIRANEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAYASOORIYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-869-6070
Mailing Address - Street 1:8224 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9096
Mailing Address - Country:US
Mailing Address - Phone:702-869-6070
Mailing Address - Fax:702-630-6080
Practice Address - Street 1:8224 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9096
Practice Address - Country:US
Practice Address - Phone:702-869-6070
Practice Address - Fax:702-630-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV40232Medicare PIN