Provider Demographics
NPI:1861854440
Name:JAYATHILAKA, DHAMMI KAUSHALYA (MD)
Entity Type:Individual
Prefix:DR
First Name:DHAMMI
Middle Name:KAUSHALYA
Last Name:JAYATHILAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DHAMMI
Other - Middle Name:KAUSHALYA KUMARI
Other - Last Name:JAYATHILAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5333 MCAULEY DR RM 5115
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1003
Mailing Address - Country:US
Mailing Address - Phone:734-434-4430
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DR RM 5115
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1003
Practice Address - Country:US
Practice Address - Phone:734-434-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300873207R00000X
390200000X
MI4301506414207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program