Provider Demographics
NPI:1023012069
Name:JAYASEELAN, NIRMAL SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:NIRMAL
Middle Name:SAMUEL
Last Name:JAYASEELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11970 N CENTRAL EXPY STE 670
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3787
Mailing Address - Country:US
Mailing Address - Phone:972-331-1116
Mailing Address - Fax:972-331-1112
Practice Address - Street 1:11970 N CENTRAL EXPY STE 670
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3787
Practice Address - Country:US
Practice Address - Phone:972-331-1111
Practice Address - Fax:972-331-1112
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8233208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030421401Medicaid
G97553Medicare UPIN
TX00483MMedicare ID - Type Unspecified