Provider Demographics
NPI:1245447838
Name:VASA, JAYASHREE (MD)
Entity type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:
Last Name:VASA
Suffix:
Gender:F
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:C203 KSR GREEN VALLEY SUBSTATION ROAD
Mailing Address - Street 2:NEAR R & B GUEST HOUSE, MADHAVADHARA
Mailing Address - City:VISHAKAPATNAM
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:530018
Mailing Address - Country:IN
Mailing Address - Phone:248-293-2830
Mailing Address - Fax:
Practice Address - Street 1:1 FORD PL
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-874-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085953208000000X
IN01088785A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics