Healthcare Provider Details

I. General information

NPI: 1588059943
Provider Name (Legal Business Name): SHANEKE THARANGE WEERAKOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 17TH ST NW STE 1250
WASHINGTON DC
20006-2517
US

IV. Provider business mailing address

5530 WISCONSIN AVE STE 700
CHEVY CHASE MD
20815-4401
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-5050
  • Fax: 301-654-4237
Mailing address:
  • Phone: 301-656-5050
  • Fax: 301-654-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0091982
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD046335
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: