Provider Demographics
NPI:1407812134
Name:SRINIVASAN, JAYASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:SRINIVASAN
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 1:801 BROADWAY STE 617
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4319
Mailing Address - Country:US
Mailing Address - Phone:206-623-0922
Mailing Address - Fax:206-623-1588
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:617
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4396
Practice Address - Country:US
Practice Address - Phone:206-623-0922
Practice Address - Fax:206-623-1588
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030207207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1009583Medicaid
WA383915OtherWA LABOR & INDUSTRIES
G70137Medicare UPIN