Provider Demographics
NPI:1578350989
Name:VANKAWALA, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:VANKAWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BELINSKY CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-2710
Mailing Address - Country:US
Mailing Address - Phone:475-224-8825
Mailing Address - Fax:
Practice Address - Street 1:12 BELINSKY CIR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-2710
Practice Address - Country:US
Practice Address - Phone:475-224-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program