Provider Demographics
NPI:1871085795
Name:JAYASIMHA, SHREYA (OD)
Entity type:Individual
Prefix:MS
First Name:SHREYA
Middle Name:
Last Name:JAYASIMHA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:SHREYA
Other - Middle Name:
Other - Last Name:JAYASIMHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:87 GRANDVIEW AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2514
Mailing Address - Country:US
Mailing Address - Phone:203-574-2020
Mailing Address - Fax:
Practice Address - Street 1:1 SASCO HILL RD # 202
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5670
Practice Address - Country:US
Practice Address - Phone:203-221-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5542152W00000X
CT003127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist