Provider Demographics
NPI:1689381311
Name:JAYASURIYA, HUGO (CNA)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:JAYASURIYA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 CHARLES EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5096
Mailing Address - Country:US
Mailing Address - Phone:732-277-4490
Mailing Address - Fax:
Practice Address - Street 1:3440 FAIRFAX RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1696
Practice Address - Country:US
Practice Address - Phone:410-940-9527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00139732376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide