Healthcare Provider Details

I. General information

NPI: 1730649898
Provider Name (Legal Business Name): DASUNI PAMODA THATHSARANI RATHNAYAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 COLE BLVD STE 100
GOLDEN CO
80401-3219
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-639-9378
  • Fax: 303-763-5495
Mailing address:
  • Phone: 720-804-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number318252
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0069447
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: