Provider Demographics
NPI:1457685588
Name:JAYARAMAN, SHIVA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:JAYARAMAN
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 1:504 E 63RD ST
Mailing Address - Street 2:APARTMENT 32M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7919
Mailing Address - Country:US
Mailing Address - Phone:917-842-8073
Mailing Address - Fax:
Practice Address - Street 1:504 E 63RD ST
Practice Address - Street 2:APARTMENT 32M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7919
Practice Address - Country:US
Practice Address - Phone:917-842-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP713452086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology