Provider Demographics
NPI:1912167602
Name:JAYASEKARA, ROSHANI (SLP)
Entity type:Individual
Prefix:MS
First Name:ROSHANI
Middle Name:
Last Name:JAYASEKARA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 BIRCHDALE DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3464
Mailing Address - Country:US
Mailing Address - Phone:510-909-1965
Mailing Address - Fax:
Practice Address - Street 1:2100 E PROVINCIAL HOUSE DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4884
Practice Address - Country:US
Practice Address - Phone:517-272-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16476235Z00000X
MIL2546701235Z00000X
GASLP012852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist