Provider Demographics
NPI:1497874945
Name:SURGICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYAKARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-755-6666
Mailing Address - Street 1:134 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2507
Mailing Address - Country:US
Mailing Address - Phone:203-755-6666
Mailing Address - Fax:203-573-6735
Practice Address - Street 1:134 GRANDVIEW AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2507
Practice Address - Country:US
Practice Address - Phone:203-755-6666
Practice Address - Fax:203-573-6735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT020045404OtherRAILROAD MEDICARE
CT0R0463OtherHEALTHNET
CT556517OtherAETNA USH
CT010024773CT02OtherANTHEM BCBS
CT0199318OtherGHI
CT130555OtherWELLCARE
CT001247733Medicaid
CT024773OtherCONNECTICARE
CT130555OtherPREFERRED ONE
CTNHS039OtherOXFORD HEALTHPLAN
CT130555OtherPREFERRED ONE
CT130555OtherWELLCARE