Provider Demographics
NPI:1851971949
Name:JAYARAM, DEBOSREE BANERJEE (NP)
Entity Type:Individual
Prefix:MISS
First Name:DEBOSREE
Middle Name:BANERJEE
Last Name:JAYARAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8005 13TH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5830
Mailing Address - Country:US
Mailing Address - Phone:931-212-5842
Mailing Address - Fax:
Practice Address - Street 1:8005 13TH ST APT 110
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5830
Practice Address - Country:US
Practice Address - Phone:931-212-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR238444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily