MEDICARE: SERENDIB HEALTHWAYS, INC

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	207K00000X	Allergy & Immunology Physician	A889910	CA
2	208D00000X	General Practice Physician	A889910	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A889910	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1902166721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENDIB HEALTHWAYS, INC

Provider Business Mailing Address
First Line	:	18543 DEVONSHIRE ST
Second Line	:	SUITE 435
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-1308
Country	:	US
Telephone Number	:	818-786-7710
Fax Number	:	818-786-7711

Provider Business Practice Location Address
First Line	:	14608 VICTORY BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1621
Country	:	US
Telephone Number	:	818-786-7710
Fax Number	:	818-786-7711

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANESRI W DE SILVA
Credential	:	M.D.
Telephone Number	:	818-305-3755

Provider Enumeration Date	:	05/26/2012
Last Update Date	:	05/26/2012

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Directions to “SERENDIB HEALTHWAYS, INC ” Practice Location

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