Healthcare Provider Details

I. General information

NPI: 1215869318
Provider Name (Legal Business Name): NETHMIE GUNATILLAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 LAKE ELLENOR DR
ORLANDO FL
32809-4633
US

IV. Provider business mailing address

340 S CANDLER AVE
ORLANDO FL
32835-1904
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-4039
  • Fax:
Mailing address:
  • Phone: 407-307-9746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: