MEDICARE: SHIRANEE JAYASOORIYA 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	208100000X	Physical Medicine & Rehabilitation Physician	10522	NV

General Provider Information

NPI Number	:	1437188513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRANEE JAYASOORIYA M.D.

Provider Business Mailing Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-869-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 W CHARLESTON BLVD
Second Line	:	#2
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9096
Country	:	US
Telephone Number	:	702-869-6070
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/08/2007

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