Healthcare Provider Details

I. General information

NPI: 1518759182
Provider Name (Legal Business Name): SHANI EKANAYAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 TOWNSGATE RD STE 102
THOUSAND OAKS CA
91361-5726
US

IV. Provider business mailing address

21425 VANOWEN ST APT 328
CANOGA PARK CA
91303-2769
US

V. Phone/Fax

Practice location:
  • Phone: 661-317-3167
  • Fax:
Mailing address:
  • Phone: 661-317-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: