Provider Demographics
NPI:1437188513
Name:JAYASOORIYA, SHIRANEE (MD)
Entity Type:Individual
Prefix:
First Name:SHIRANEE
Middle Name:
Last Name:JAYASOORIYA
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 1:8224 W CHARLESTON BLVD
Mailing Address - Street 2:#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:
Practice Address - Street 1:8224 W CHARLESTON BLVD
Practice Address - Street 2:#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:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10522208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H91679Medicare UPIN
NV40234Medicare ID - Type Unspecified