Healthcare Provider Details

I. General information

NPI: 1972168938
Provider Name (Legal Business Name): ISURUNI GAYANATHIKA SONNADARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 34TH AVE STE 202
OCALA FL
34474-7408
US

IV. Provider business mailing address

6675 WESTWOOD BLVD STE 475
ORLANDO FL
32821-6027
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-2575
  • Fax: 352-505-7329
Mailing address:
  • Phone: 407-845-0330
  • Fax: 888-972-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019009322
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1431
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: