Provider Demographics
NPI:1700844271
Name:SHETTY, JAYAPRAKASH B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYAPRAKASH
Middle Name:B
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N MAIN STRET
Mailing Address - Street 2:
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-0839
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:860-779-5437
Practice Address - Street 1:132 MANSFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2027
Practice Address - Country:US
Practice Address - Phone:860-456-2261
Practice Address - Fax:860-450-1357
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT250582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F18333Medicare UPIN
CT260003512Medicare ID - Type Unspecified