Provider Demographics
NPI:1922061738
Name:SHETTY, JAYAKARA (MD)
Entity Type:Individual
Prefix:
First Name:JAYAKARA
Middle Name:
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 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-568-2929
Mailing Address - Fax:203-568-2921
Practice Address - Street 1:1625 STRAITS TPKE
Practice Address - Street 2:SUITE #200
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1836
Practice Address - Country:US
Practice Address - Phone:203-568-2929
Practice Address - Fax:203-568-2921
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT024773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD19514Medicare UPIN