Active NPI
Shantal Jayawickreme, MD
- Hospitalist Physician
- Wilkes Barre, PA
National Provider Identifier
1053015727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- MD495918
- Practice address
- 1000 E Mountain Dr
Wilkes Barre, PA 18711-0027 - Phone
- (570) 808-7399
- Fax
- (570) 808-5942
- NPI assigned
- Mar 28, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | MD495918 | PA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Mailing address
100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-7399
Other practice location 1
2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230621000229 | NC | Order and Referring Only - Internal Medicine | 5294193496 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- sjayawickreme546835@direct.medicine.duke.edu
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788998400000",
"number": "1053015727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N ACADEMY AVE",
"city": "DANVILLE",
"state": "PA",
"postal_code": "178224903",
"telephone_number": "570-808-7399",
"fax_number": "570-808-5942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E MOUNTAIN DR",
"city": "WILKES BARRE",
"state": "PA",
"postal_code": "187110027",
"telephone_number": "570-808-7399",
"fax_number": "570-808-5942"
}
],
"practiceLocations": [
{
"address_1": "2301 Erwin Rd",
"address_purpose": "LOCATION",
"city": "Durham",
"state": "NC",
"postal_code": "277054699",
"country_code": "US",
"telephone_number": "919-684-8111",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JAYAWICKREME",
"first_name": "SHANTAL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-28",
"last_updated": "2026-09-10",
"certification_date": "2026-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "PA",
"license": "MD495918",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilkes Barre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.