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Individual

SURESH JAYANTHA DESILVA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
21332 NAUTIQUE BLVD, APT # 204, CORNELIUS, NC 28031-6410
(704) 650-3789
Mailing address
21332 NAUTIQUE BLVD, APT # 204, CORNELIUS, NC 28031-6410
(704) 650-3789

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
00971315
NC
207P00000X
Emergency Medicine Physician
Primary
13961
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2246349F
MEDICARE PART B PROVIDER #
NC
05
89107OL
NC
Enumeration date
04/07/2006
Last updated
03/14/2024
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