Healthcare Provider Details

I. General information

NPI: 1265474951
Provider Name (Legal Business Name): EAST END NEPHROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MANOR PL SUITE # 102
GREENPORT NY
11944-1261
US

IV. Provider business mailing address

222 MANOR PL SUITE # 102
GREENPORT NY
11944-1261
US

V. Phone/Fax

Practice location:
  • Phone: 631-477-1755
  • Fax: 631-477-1754
Mailing address:
  • Phone: 631-477-1755
  • Fax: 631-477-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARMINI JAYAMAHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-477-1755