Provider Demographics
NPI:1659699718
Name:SESHADRI, JAYASHREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:SESHADRI
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 1:6501 LOISDALE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1826
Mailing Address - Country:US
Mailing Address - Phone:571-305-3090
Mailing Address - Fax:
Practice Address - Street 1:6501 LOISDALE CT STE 1100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1885
Practice Address - Country:US
Practice Address - Phone:571-305-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46013207R00000X
390200000X
VA0101263990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
12571830OtherCAQH