MEDICARE: DR. KRISHANTHI JAYATHILAKA M.D.

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	208D00000X	General Practice Physician	15400	NV
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	15400	NV

General Provider Information

NPI Number	:	1811296585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISHANTHI JAYATHILAKA M.D.

Provider Business Mailing Address
First Line	:	2440 W HORIZON RIDGE PKWY STE 130
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2731
Country	:	US
Telephone Number	:	702-881-8191
Fax Number	:	959-207-1248

Provider Business Practice Location Address
First Line	:	2440 W HORIZON RIDGE PKWY STE 130
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2731
Country	:	US
Telephone Number	:	702-881-8191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	09/01/2023

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