Provider Demographics
NPI:1912942558
Name:JAYAMAHA, SHARMINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMINI
Middle Name:
Last Name:JAYAMAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 MANOR PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1261
Mailing Address - Country:US
Mailing Address - Phone:631-477-1755
Mailing Address - Fax:631-477-1754
Practice Address - Street 1:632 ROANOKE AVENUE
Practice Address - Street 2:EAST END NEPHROLOGY, P.C.
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-208-8270
Practice Address - Fax:631-208-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2012-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY212805207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360956Medicaid
NY02360956Medicaid
H45447Medicare UPIN