Provider Demographics
NPI:1891014148
Name:JAYASURIYA, SASANKA NISHANI (MD)
Entity type:Individual
Prefix:DR
First Name:SASANKA
Middle Name:NISHANI
Last Name:JAYASURIYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2301 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4508
Mailing Address - Country:US
Mailing Address - Phone:414-298-7230
Mailing Address - Fax:414-298-7231
Practice Address - Street 1:2301 N LAKE DR STE 406
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-298-7230
Practice Address - Fax:414-298-7231
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR70499207RC0000X
WI70659207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease