Healthcare Provider Details

I. General information

NPI: 1588274815
Provider Name (Legal Business Name): PRADILKA PERERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W BROWN RD
MESA AZ
85201-3227
US

IV. Provider business mailing address

570 W BROWN RD
MESA AZ
85201-3227
US

V. Phone/Fax

Practice location:
  • Phone: 480-344-2177
  • Fax:
Mailing address:
  • Phone: 480-344-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number69348
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: