MEDICARE: DR. HIMALI JAYAKODY MD

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	208000000X	Pediatrics Physician	R- 8547	IA
2	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME119541	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	I4V0M	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346479854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIMALI JAYAKODY MD

Provider Business Mailing Address
First Line	:	170 PINE AVE N
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4629
Country	:	US
Telephone Number	:	813-553-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 PINE AVE N
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-4629
Country	:	US
Telephone Number	:	480-652-2110
Fax Number	:

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	12/03/2024

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