Provider Demographics
NPI:1285080747
Name:OBEYSEKARE, JESSICA L (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:OBEYSEKARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:401-455-6375
Mailing Address - Fax:
Practice Address - Street 1:109 PHYSICIANS DR STE B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2446
Practice Address - Country:US
Practice Address - Phone:864-797-9170
Practice Address - Fax:864-797-9175
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP035902084P0800X
SC839402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC839409Medicaid