Provider Demographics
NPI:1437186483
Name:JAYASEKERA, KANEWELA A (MD)
Entity Type:Individual
Prefix:
First Name:KANEWELA
Middle Name:A
Last Name:JAYASEKERA
Suffix:
Gender:M
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:CONNECTIONS, 3479 BUCKHORN DR.
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1294
Mailing Address - Country:US
Mailing Address - Phone:859-271-3812
Mailing Address - Fax:859-967-1069
Practice Address - Street 1:EASTERN STATE HOSPITAL
Practice Address - Street 2:627 W 4TH ST
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-1294
Practice Address - Country:US
Practice Address - Phone:859-246-7558
Practice Address - Fax:859-246-7023
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY182172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00022290OtherRR MEDICARE
KY18217Medicaid
KYP00022290OtherRR MEDICARE
KYD94212Medicare UPIN