Healthcare Provider Details

I. General information

NPI: 1629562079
Provider Name (Legal Business Name): JAYASAI JEYARAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 FLY ROAD STE 305
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

251 SALINA MEADOWS PARKWAY STE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3938
  • Fax: 315-464-5359
Mailing address:
  • Phone: 315-464-2096
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD482791
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number345119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: