Healthcare Provider Details

I. General information

NPI: 1780882449
Provider Name (Legal Business Name): DESHINI A MOONESINGHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2007
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8904 BASH ST STE B
INDIANAPOLIS IN
46256-1286
US

IV. Provider business mailing address

8904 BASH ST STE B
INDIANAPOLIS IN
46256-1286
US

V. Phone/Fax

Practice location:
  • Phone: 317-735-6001
  • Fax: 855-450-1177
Mailing address:
  • Phone: 317-735-6001
  • Fax: 855-450-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number01067139A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01067139A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01067139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: