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General NPI Number Information
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NPI Number | 1043507833
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Entity Type | Individual
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Provider Name | HARSHINI A JAYASURIYA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 2205 JOLLY RD STE B
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City | OKEMOS
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State | MI
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Zip | 48864-3983
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Country | US
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Telephone | 517-347-4085
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Fax | 517-347-4170
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Provider Business Mailing Address
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Address Line | PO BOX 639295 DEPT 93394
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City | CINCINNATI
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State | OH
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Zip | 45263-9295
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Country | US
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Telephone | 248-266-4200
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Fax | 855-618-6655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.167374
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01091856A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2024-0792
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TPME6793
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35C.000284
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301098352
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3581-320
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License Number State | WI
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