Healthcare Provider Details

I. General information

NPI: 1871085795
Provider Name (Legal Business Name): SHREYA JAYASIMHA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SHREYA JAYASIMHA

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SASCO HILL RD # 202
FAIRFIELD CT
06824-5670
US

IV. Provider business mailing address

87 GRANDVIEW AVE STE B
WATERBURY CT
06708-2514
US

V. Phone/Fax

Practice location:
  • Phone: 203-221-0545
  • Fax:
Mailing address:
  • Phone: 203-574-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5542
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003127
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: