Healthcare Provider Details

I. General information

NPI: 1659699718
Provider Name (Legal Business Name): JAYASHREE SESHADRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT STE 1100
SPRINGFIELD VA
22150-1885
US

IV. Provider business mailing address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

V. Phone/Fax

Practice location:
  • Phone: 571-305-3090
  • Fax:
Mailing address:
  • Phone: 571-305-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46013
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101263990
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: