MEDICARE: DR. SHIRANEE JAYASOORIYA INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician		NV

General Provider Information

NPI Number	:	1225067408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SHIRANEE JAYASOORIYA INC

Provider Business Mailing Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-869-6070
Fax Number	:	702-630-6080

Provider Business Practice Location Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-869-6070
Fax Number	:	702-630-6080

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SHIRANEE M. JAYASOORIYA
Credential	:	MD
Telephone Number	:	702-869-6070

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	08/20/2008

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