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NPI Code Detail

MEDICARE: MRS. SAMURDHI JAYAWEERA ROBERTS PA-C

MEDICARE: MRS. SAMURDHI JAYAWEERA ROBERTS PA-C
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
1363A00000XPhysician Assistant3822SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467774042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SAMURDHI JAYAWEERA ROBERTS PA-C
Provider Business Mailing Address
First Line : PO BOX 751649
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1649
Country : US
Telephone Number : 843-789-1620
Fax Number :
Provider Business Practice Location Address
First Line : 3885 W ASHLEY CIR STE F600
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-9273
Country : US
Telephone Number : 843-402-1360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2010
Last Update Date : 05/19/2023

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