Provider Demographics
NPI:1548239726
Name:KOLLI, JAYASELVI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASELVI
Middle Name:
Last Name:KOLLI
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 1:6934 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2876
Mailing Address - Country:US
Mailing Address - Phone:716-297-7898
Mailing Address - Fax:716-297-7899
Practice Address - Street 1:6934 ELAINE DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2876
Practice Address - Country:US
Practice Address - Phone:716-297-7898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02500470Medicaid
NY01872288Medicaid
NY01872288Medicaid