Provider Demographics
NPI:1558650325
Name:PAYAPPAGOUDAR, JAYASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:PAYAPPAGOUDAR
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 1:6600 MADISON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-1971
Mailing Address - Country:US
Mailing Address - Phone:727-815-7208
Mailing Address - Fax:727-266-4951
Practice Address - Street 1:6600 MADISON ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-1971
Practice Address - Country:US
Practice Address - Phone:727-815-7208
Practice Address - Fax:727-266-4951
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255894207Q00000X
FLME125088207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018755500Medicaid
FL018755500Medicaid
FLIR731YMedicare PIN
FLP01795762Medicare PIN