Provider Demographics
NPI:1871484477
Name:JAYASURIYA, JANUDI P
Entity type:Individual
Prefix:
First Name:JANUDI
Middle Name:P
Last Name:JAYASURIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SHEFFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3014
Mailing Address - Country:US
Mailing Address - Phone:714-746-9408
Mailing Address - Fax:
Practice Address - Street 1:2050 W CHAPMAN AVE STE 122
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2648
Practice Address - Country:US
Practice Address - Phone:949-989-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician