Provider Demographics
NPI:1902216088
Name:KARIYAWASAM, SHASHI
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:
Last Name:KARIYAWASAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSE LN
Mailing Address - Street 2:APT. 10-14
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-6719
Mailing Address - Country:US
Mailing Address - Phone:203-770-4475
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-770-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine