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General NPI Number Information
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NPI Number | 1891014148
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Entity Type | Individual
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Provider Name | SASANKA NISHANI JAYASURIYA MD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2010
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 2301 N LAKE DR STE 406
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City | MILWAUKEE
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State | WI
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Zip | 53211-4508
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Country | US
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Telephone | 414-298-7230
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Fax | 414-298-7231
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Provider Business Mailing Address
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Address Line | 2301 N LAKE DR
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City | MILWAUKEE
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State | WI
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Zip | 53211-4508
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Country | US
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Telephone | 414-298-7230
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Fax | 414-298-7231
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R70499
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 70659
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License Number State | WI
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