MEDICARE: HILDA JAYAWARDENA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	NYS 123119	NY

General Provider Information

NPI Number	:	1174549448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILDA JAYAWARDENA M.D.

Provider Business Mailing Address
First Line	:	17 SHERWOOD HEIGHTS
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3408
Country	:	US
Telephone Number	:	914-474-3271
Fax Number	:	845-297-0179

Provider Business Practice Location Address
First Line	:	17 SHERWOOD HEIGHTS
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-3408
Country	:	US
Telephone Number	:	914-474-3271
Fax Number	:	845-297-0179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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