MEDICARE: MRS. NIMMI NIMESHA WICKRAMASURIYA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084V0102X	Vascular Neurology Physician	036180492	IL

General Provider Information

NPI Number	:	1053052951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIMMI NIMESHA WICKRAMASURIYA M.D.

Provider Business Mailing Address
First Line	:	1430 TULANE AVE # 8065
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2632
Country	:	US
Telephone Number	:	504-988-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 TULANE AVE # 8065
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2632
Country	:	US
Telephone Number	:	504-988-2652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	06/11/2026

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